bluuebunny/crossref_metadata_2025_split huggingface dataset:
OSTEOSARCOMA AND PULMONARY METASTASES: 15‐YEAR EXPERIENCE FROM A SINGLE INSTITUTION
Authors: Ellis Peter M. , Tattersall Martin H. N. , McCaughan Brian , Stalley Paul 
Published: January 2008

Background: The outcome of management in patients with osteosarcoma and pulmonary metastases at a Sydney teaching hospital was reviewed.Methods: A retrospective review was undertaken of all patients diagnosed with osteosarcoma and treated by the Bone and Soft Tissue Unit and the Medical Oncology Department, Royal Prince Alfred Hospital between 1979 and January 1995. Information was collected on demographics, tumour site, tumour histology, primary management including surgery and adjuvant therapy, and the subsequent development and management of pulmonary metastases.Results: A total of 56 patients with localized osteosarcoma was seen. Overall survival and survival following pulmonary metastases was assessed. There were 33 (59%) males and 23 (41%) females, with a median age of 27 years. Survival at 5 years, for patients with non‐axial osteosarcoma was 60% (95%CI, 44–77%). Pulmonary metastases without other metastatic disease being apparent, developed in 22 patients, of whom 12 underwent surgical resection. The median disease‐free interval of these latter patients was 20 months (95% CI, 8–32 months). Median survival among patients not undergoing surgical resection was 5 months from detection of metastases. Patients undergoing resection of pulmonary metastases had a median survival of 17 months following detection of pulmonary metastases (95% CI, 7–27 months). Actuarial 5‐year survival was 16% (95% CI, 0–42%).Conclusions: A small proportion of patients with resectable pulmonary metastases from osteosarcoma achieve long‐term disease‐free survival following surgical resection. It is not possible to accurately identify these patients prospectively.
THE CLINICAL ROLE OF SHOULDER ULTRASOUND
Authors: Sonnabend D. H. , Hughes J. S. , GIUFFRE B. M. , Farrell R. 
Published: January 2008

Background: Rotator cuff surgery is facilitated by accurate pre‐operative information regarding the presence and size of cuff tears, and the extent of any cuff retraction or lamination. Methods: A total of 117 consecutive patients who underwent shoulder ultrasound followed by surgical management were assessed, and the pre‐operative ultrasound diagnoses were correlated with the operative findings. Results: Ultrasound was found to be reliable for the detection of full‐thickness cuff tears (positive predictive value 96%). In the assessment of partial thickness tears, ultrasound produced few false positives, but failed to diagnose a significant proportion of these lesions. Lamination and other interstitial cuff pathology were not reliably detected by ultrasound. In the diagnosis of subacromial impingement, ultrasound produced few false positives (positive predictive value 95%), but did produce a significant number of false negative results (negative predictive value 66%). Conclusions: Ultrasound is cheaper than MRI and arthrography, and is both non‐invasive and ‘dynamic’. It is reliable in the diagnosis of full‐thickness cuff tears and is a useful adjunct in the diagnosis of cuff impingement and partial thickness tears, but is very much operator‐dependent.
TREATMENT OF ABDOMINAL AORTIC ANEURYSM DISEASE IN THE 9TH AND 10TH DECADES OF LIFE
Authors: Robinson David , Englund Raymond , Hanel Kevin C. 
Published: January 2008

Background: The appropriate management of patients who are older than 80 years of age and who present with an abdominal aortic aneurysm (AAA) remains controversial. While it appears that elective repair can be performed safely, appropriate management of these patients in the emergency situation is unclear. The purpose of the present study was to examine the results obtained in treating this elderly group in the elective and emergency setting, by operation and conservative techniques at St George Hospital, Kogarah. Methods: Between January 1987 and December 1994 85 patients older than 80 years of age were treated for AAA. These patients were divided into four groups: I, elective presentatiodno surgery; II, elective presentatiodelective surgical repair; III, emergency presentatiodsurgical repair; and IV, emergency presentatiodconservative treatment. We examined age, sex, size of AAA, mode of presentation, type of treatment, length of survival and cause of death. Results: The mean age of the total group (n = 85) of patients was 84 years (range: 80–94). The mean AAA diameter for this group was 5.6 cm (95% CI: 5.2–6 cm). The diameters for group I (n= 40), II (n= 22), III (n= 16) and IV (n = 7) were 4.9 cm (4.4–5.5, 95% CI), 5.7 (4.9–6.5 CI), 7.0 (6.1–7.7 CI) and 6.2 (5.2–7.2 CI), respectively. The median survival for groups I, II, III and IV was 18, 38.5, 0.25 and 0 months, respectively. Group II had a longer survival than any other group (P= 0.015). and group IV had a shorter survival than the total group (P= 0,001). However, the length of survival was no different for III versus IV (P= 0.146). Deaths in each group were due to the following reasons. I: cardiopulmonary events (14), rupture (3), malignancy/sepsis (3); II: cardiopulmonary events (3), rupture (thoracic aneurysm) (2). malignancy (1); III: rupture (10), malignancy (1); and (IV): rupture (6), malignancy (1). Conclusions: Elective surgical repair offers the best management option for AAA in patients older than 80 years of age. Death may still occur from progression of aneurysmal disease at other sites. An aggressive surgical approach to the management of haemodynamically unstable patients in this age group is of questionable benefit.
LEG WOUND INFECTIONS ASSOCIATED WITH CORONARY REVASCULARIZATION
Authors: Wong Shing Wai , Fernando Devaka , Grant Peter 
Published: January 2008

Background Wound infections after saphenous vein harvest for coronary revascularization are common but they are infrequently examined. The aim of the present study was to investigate the risk factors for infection and the possible beneficial effects of saline lavage. Methods: From April 1996 to July 1996, 152 consecutive patients who underwent saphenous vein harvest for coronary artery bypass graft were recruited. Factors that may influence infection rates were analysed. Results: A total of 22 of the 125 (18%) patients included in the present study developed a wound infection. The length of the wound was the only variable found to have a statistically significant association with wound infection. In the analysis of patients with multiple leg wounds, the development of infection correlated with the absence of mechanical wash‐out. Conclusion: The use of saline lavage may prevent wound infections by diluting the bacterial population prior to closure. The use of antiseptic or antibiotic lavage may offer an additional benefit.
MELIOIDOTIC OSTEOMYELITIS IN NORTHERN AUSTRALIA
Authors: Popoff Ivan , Nagamori Jun , Currie Bart 
Published: January 2008

Background: Osteomyelitis is a well‐recognized manifestation of melioidosis, a significant disease that is endemic in South‐East Asia and northern Australia. Diagnosis requires a high degree of clinical suspicion and is dependent on microbiological confirmation; important clues are travel to or residence in an endemic area. Infection often but not always occurs in well‐recognized risk groups, especially diabetics and alcoholics. Subacute presentations often mimic other disease processes and patients may not always be clinically septic. Treatment requires surgical drainage in combination with multiple antibiotic therapy, including at least 2 weeks of intravenous ceftazidime and oral therapy continuing for 3–6 months. Non‐compliance usually results in relapse. Due to the potential long latency of the disease and the possibility of reactivation, follow‐up should probably be life‐long. Methods: A prospective study of 115 patients presenting with melioidosis between 1989 and 1995 was undertaken. Results: Four patients were found to have osteomyelitis. Conclusion: It is important to be aware of this condition so that early treatment can be initiated.
MILITARY SURGERY IN RWANDA
Authors: Farrow Glendon B. , Rosenfeld Jeffrey V. , Crozier John A. , Wheatley Peter , Warfe Peter 
Published: January 2008

Background: In April of 1994, a vicious civil war erupted in Rwanda, with more than 500 000 people massacred by extremist militias. The second United Nations Assistance Mission in Rwanda (UNAMIR II) deployed in August 1994 to monitor the ceasefire. with an Australian Defence Force Contingent of Health Service Support consisting of staff for the UNAMIR Headquarters, and the Australian Medical Support Force (AS MSF). Methods: A retrospective audit was conducted of all operative surgery performed during the year‐long deployment. in the AS MSF operating theatres. Results: Twenty surgeons rotated through in 6‐week intervals. A total of 750 operations were performed on 547 patients, of which 636 (84.8%) involved civilians. A total of 558 (74.4%) cases were the result of trauma both accidental (38.4%) and war related (36%). The mean age of patients was 21.7 years. The age distribution was skewed, with 289 (38.5%) cases being performed on children. General surgeons performed a wide range of surgery, covering the majority of surgical specialties. These included cardiothoracic, neurosurgical, vascular and paediatric cases. Orthopaedic surgeons dealt with amputations, debridements and skin grafting in addition to bony injuries and infections. Children formed a substantial number of those treated, and required surgery for war‐related injuries significantly more often than adults. Conclusions: Surgeons involved in future peacekeeping missions should be aware of the broad variety of clinical problems encountered, and undertake refresher training in the sub‐specialties. Children are at great risk of violence in war, and if a civilization can be judged by the protection it affords its helpless, the Rwandan genocide and ensuing civil war represents a horrific example of the opposite extreme.
THE RELATIONSHIP OF CERVICAL LYMPH NODE METASTASES TO PRIMARY SITES OF CARCINOMA OF THE UPPER AERODIGESTIVE TRACT: A PATHOLOGICAL STUDY
Authors: Cole Ian , Hughes Louise 
Published: January 2008

Background:Therapeutic and elective dissection of the neck is accepted management in the treatment of squamous cell carcinoma (SCC) of the upper aerodigestive tract (UADT). Accurate histological assessment of the levels of involvement of cervical metastatic spread from different sites within the UADT has allowed the increasing use of less than radical procedures, with associated reduced morbidity. Methods: A total of 168 necks in 126 patients were examined pathologically. All levels were identified at surgery, marked and orientated by pinning the specimen to a cork board, and examined histologically. A total of 114 necks had a comprehensive neck dissection (CND) in which all levels were dissected. The number and level of involvement and the occult rate (114 necks) for each primary site was assessed. Of the total of 168 necks, 80 had pathologically involved nodes, and the number with greater than one node involved (N2b)was compared for each primary site. The number with extracapsular spread for each nodal staging was also examined. Results:The sites of primary SCC were the oral cavity, oropharynx, hypopharynx, supraglottic and glottic larynx. In those patients with a primary in the oral cavity, no patient had level 5 involvement, but in two patients (7%) level 4 was involved. In the oropharynx, level 1 and 5 were involved in two patients (11%) each. In the hypopharynx, level 1 was not involved in any patient, however, level 5 contained metastasis in 7 (23%). In the supraglottic larynx, level 1 was involved in one (4%) patient and level 5 was involved in three (11%). In the glottis only one patient had bilateral multiple nodes which included level 5. In no case was level 5 involved without positive nodes in other levels. The occult rate for each primary site was 45%, 22%, 77%, 54% and 29%, respectively. The multiple node rate in the 80 necks with positive nodes was, respectively, 31%, 54%, 66%, 45% and 40%. All patients with a node larger than 3 cm had extracapsular spread of tumour. Conclusions: The level of nodal involvement and therefore the type of neck dissection should be determined by the site of the primary within the UADT and the presence or absence of nodes at surgery. There is a high number (39–66%) of pathologically involved necks which have multiple nodes and also nodes with extracapsular spread of tumour, which may influence the decision for postoperative radiotherapy.
DOES A TEACHING PROGRAMME IN DAY SURGERY IMPACT ON EFFICIENCY AND QUALITY OF CARE?
Authors: Rudkin Glenda E. , O'Driscoll Mary C. E. , Carty Vanessa M. 
Published: January 2008

Background:Recent medical advances have led to an explosion in the use of day surgery, making traditional teaching untenable and necessitating a transfer of undergraduate teaching programmes into the day surgery setting. Concerns have been raised about the impact of teaching on efficiency and quality of care in this environment. Methods: Thirty‐one final year medical students participated in a new teaching programme conducted in a dedicated day surgery unit in a major Australian public teaching hospital. Five commonly performed procedures were audited and analysed by a mixed model analysis of variance to determine whether students impacted significantly on operation time. Student performance was monitored using a logbook. Surgeons and nursing staff completed questionnaires about their perceptions of the impact of the programme on the overall efficiency of the day surgery unit. Results:Students had no significant effect on operation time for the procedures examined. Staff did not perceive that students had significantly detracted from the overall efficiency of the unit. An unexpected finding was the substantial contribution that students made to quality of patient care. Conclusions:A successful undergraduate medical teaching programme can be conducted in a day surgery setting without compromising efficiency and quality of care.
MANAGEMENT AND OUTCOME OF POPLITEAL ARTERY ANEURYSMS IN A NEW ZEALAND PROVINCIAL CENTRE
Authors: Dijkstra Birgit , Fleischl John , Knight Douglas 
Published: January 2008

Background: The experience of management of popliteal artery aneurysms (PAA) in a provincial centre is described. Methods: Patients were identified from vascular audit, and case notes were reviewed retrospectively. Results: There were 17 patients with 23 PAA over 12 years. All patients were male, with a mean age of 73 years. Other aneurysms were present in 77% of patients, 59% had bilateral PAA and 41% had an associated abdominal aortic aneurysm (AAA). Mean follow‐up was 3 years, 3 months (range, 1 month‐7 years). There were 11 acute procedures, and 12 elective. Reconstruction with bypass and ligation of the aneurysm was performed in all elective and 9/11 acute procedures. Of the 21 bypass procedures, 17 used autologous vein, three used GoreTex, and 1 composite graft. There were two PAA that were not reconstructable. All the vein grafts remained patent during the time of follow‐up, but two of the three GoreTex grafts failed. Succesful reconstruction was achieved in 11/12 elective and 9/11 acute cases. All grafts in the acute group remained patent during the time of follow‐up (mean, 3.5 years), in the elective group 11/12 grafts (91%) remained patent (mean follow‐up, 2.5 years). Conclusions: An excellent outcome was achieved in both elective and acute procedures. Autologous vein grafts appear to give better results than synthetic grafts. Due to the high incidence of multiple aneurysms, screening for other aneurysms is suggested.
FRESH OSTEOCHONDRAL ALLOGRAFTS: A 6–10‐YEAR REVIEW
Authors: Fitzpatrick P. L. , Morgan D. A. F. 
Published: January 2008

Background: In young patients with limited articular cartilage damage, osteochondral allografts may offer an alternative to total joint replacement. The survival of chondrocytes after transplantation and the correlation with clinical outcomes was studied. Methods: Between March 1987 and September 1990, nine patients received fresh osteochondral allografts. Three patients received tibial plateau transplants, three received patellar transplants, two received proximal interphalangeal joints and the remaining patient received segmental femoral head allograft. Patient ages ranged from 16–51 years (mean = 30). They have been followed in prospective manner for up to 10 years with clinical, radiographic and histopathological review during that period. Results: Early histological analyses demonstrated preservation of hyaline cartilage. Subsequent analyses from the periphery of some grafts demonstrated chondrocyte death and change from hyaline cartilage to fibrocartilage, but one specimen taken from the centre of tibial plateau graft, nine years after transplantation, demonstrated viable chondrocytes. The three tibial plateau recipients improved at clinical level from an average pre‐operative score of 73 (HSS 0–200) to postoperative average of 174 points. Two of those patients receiving patellar allografts improved from 91 points to 181 points on average. The third patella allograft recipient underwent total knee replacement 18 months post‐transplantation. The patella was not resurfaced. The proximal interphalangeal joint transplants failed and the femoral head allograft has been lost to follow‐up. Conclusions: The clinical success of the tibial plateau and patellar allografts, irrespective of the histological results, has resulted in the formulation of code of specific indications for this operation. Future enthusiasm, although buoyed by the possibility of long‐term chondrocyte viability and good clinical results, must be tempered by the ever‐present risk of disease transmission.
LAPAROSCOPY IN THE MANAGEMENT OF DIAPHRAGMATIC RUPTURE DUE TO BLUNT TRAUMA
Authors: Martin Ian , O'Rourke Nicholas , Gotley David , Smithers Mark 
Published: January 2008

Background: Traumatic diaphragmatic rupture remains diagnostic challenge often unrecognized until laparotomy in over 40% of patients and the diagnosis is delayed in further 15%. This report describes four patients diagnosed at laparoscopy with ruptured diaphragm. Methods: One patient had left diaphragmatic rupture amenable to laparoscopic repair in the emergency setting. Three patients underwent laparoscopy 2, 7 and 10 days after injury which revealed two right‐sided and one extensive left‐sided rupture, respectively; each required open repair. Results: While laparoscopy is an excellent diagnostic tool, particularly in the delayed setting, repair is not possible for right‐sided ruptures because of the liver bulk. Conclusions: Thoracoscopy in the instance of delayed presentation may offer the best chance for minimal‐access diagnosis and treatment when there is suspicion of right‐sided diaphragmatic rupture.
CARCINOMA OF THE MALE BREAST: A REVIEW AND RECOMMENDATIONS FOR MANAGEMENT
Authors: Carmalt Hugh L. , Mann Lynnette J. , Kennedy Catherine W. , Fletcher Julie M. , Gillett David J. 
Published: January 2008

Background: Male breast cancer is rare and experience of it in any single institution is limited. The aim of this study was to evaluate the presentation, management and outcome of male patients with breast cancer treated at Concord Repatriation General Hospital hospital over a 38‐year period and to determine a best‐practice protocol based on the results and a review of the literature. Methods: A total of 42 patients were retrospectively reviewed, pathology slides were re‐examined and reclassified where necessary. Outcome was assessed and compared with results obtained from a literature review. Results: A trend towards less radical surgery has emerged. Overall 5‐year survival was 50%, but, due to the late age at presentation, more than half the deaths were non‐breast cancer related. One quarter of the patients presented with locally advanced or metastatic disease. Conclusions: The presentation, diagnosis pathology and outcome of breast cancer are similar in men and women, although the disease occurs at a later age in men. Radical surgery is not required in order to gain local control, but knowledge of axillary node status is important in determining prognosis and the need for adjuvant therapy.
MINI‐LAP CHOLECYSTECTOMY: A VIABLE ALTERNATIVE TO LAPAROSCOPIC CHOLECYSTECTOMY FOR THE THIRD WORLD?
Authors: Sharma Atul K. , Rangan Harihar K. , Choubey Rajender P. 
Published: January 2008

Background: Laparoscopic cholecystectomy (LC) requires expensive equipment and special training. Mini–lap cholecystectomy (MLC) has no start–up costs but no large series from single centre has been reported as the procedure is considered hazardous because of inadequate exposure of the surgical field. Methods: We retrospectively reviewed the outcome of 737 cholecystectomies performed through 3‐5‐cm transverse subcostal incision and compared the results to published series of laparoscopic cholecystectomy. Results: The operating time (61.6 min; range 35–130), conversion rate (4%), rate of postoperative complications (3.6%), bile duct injuries (0.3%), number of analgesic doses required (3.4; range 3–8), duration of postoperative hospital stay (1.4; range 1–15 days), and the time off work (13.3 days; range 8–61) compare well with the reported results of laparoscopic and MLC. Ninety–three per cent of the patients were followed up for median period of 28.4 months and none developed biliary stricture. Conclusions: Mini–lap cholecystectomy is considered safe, viable alternative to LC in the Third World.
A PROSPECTIVE AUDIT OF LICHTENSTEIN'TENSION‐FREE HERNIORRHAPHY IN TARANAKI, NEW ZEALAND
Authors: Hulme‐Moir M. , Kyle S. 
Published: January 2008

Background: This study was undertaken to assess the outcome of Lichtenstein'tension‐free mesh inguinal herniorrhaphy as practised by surgeons in a provincial centre in Taranaki, New Zealand. Methods: A prospective audit was carried out on all patients who underwent this procedure in Taranaki. They were followed up at 1 month and again at 1 year. Results were entered on a standardized pro forma. Results: One hundred and twenty‐four patients underwent 134 repairs by four different surgeons and their registrars. Eighty‐two per cent of them had a general anaesthetic, and 13% had local anaesthestic. Twenty‐five per cent of the repairs were performed as day surgery and a further 53% required overnight stays. Complication rates were 6% in hospital, 12.7% at 1 month and 8% at 1 year. Recurrence occurred in one repair (0.9%) and there were no cases of mesh rejection. The wound infection rate was 3% and all were minor. Only 45% of the patients who had an inguinal herniorrhaphy were employed and they took an average of 16 days (range 2–30) to return to work. Over half felt that that they could have returned to normal activities within 2 weeks. Conclusions: The Lichtenstein technique of inguinal herniorrhaphy is a technically simple, reliable procedure with minimal morbidity and patients may expect a reasonably prompt return to work and to normal activities.