bluuebunny/crossref_metadata_2025_split huggingface dataset:
ANATOMICAL LANDMARKS OF THE INGUINAL CANAL IN PREPUBESCENT CHILDREN
Authors: Parnis S. J. , Roberts J. P. , Hutson J. M. 
Published: January 2008

Background: Most adult anatomical texts state that the deep inguinal ring is situated midway between the anterior superior iliac spine and the pubic tubercle. The aim of this study was to determine if this was true in prepubescent children. Methods: A total of 107 inguinal ligaments and canals were measured during inguinal operations in 80 children (68 boys, age range 1–118 months). Results: The length of the inguinal ligament increased from a median of 4.3 cm (range 3.6–6.8) at less than 1 year of age to 7.5 cm (range 6.7–10.1) at over 4 years of age. The internal ring was situated medial to the midpoint of the inguinal ligament throughout childhood. The ratio of internal ring to pubic tubercle over inguinal ligament length was 42% (range 27–58) at less than 2 years; and 34% (range 25–46) at over 4 years. The inguinal canal remained short (median 1 cm (range 0.7–1.1) at less than 2 years, and median 1.1 cm (range 0.7–2.3) at over 4 years) suggesting that growth of the inguinal region in this age group occurs outside the canal. Conclusions: These results have implications for the siting of incisions, and question the necessity of opening the inguinal canal in children.
AN AUDIT OF EARLY HOSPITAL READMISSION AFTER PRIMARY KNEE JOINT REPLACEMENT
Authors: Bedi Harvinder S. , Fletcher Scott F. , Rush Jonathan H. , Choong Peter F. M. 
Published: January 2008

Background: Hospital readmissions following arthroplasty represent a considerable burdern to the community. The present study investigates the magnitude of this problem and the reasons for early readmission. Methods: The medical records of patients who underwent primary knee joint replacements between July 1989 and December 1994 were reviewed retrospectively. Readmission within 12 months of surgery was noted and the prognosis of these patients assessed. Results: A total of 160 patients (180 arthroplasties) were appropriate for review. The readmission rate for knee‐related morbidity was 18%. The main reasons for this included pain, stiffness, and the investigation/management of an inflamed joint. Notably, patellofemoral disease was common, particularly in the group without resurfaced patellae, manipulation of a stiff joint was rarely effective unless instituted early and aetiologies aside from sepsis often resulted in the patient returning with an inflamed joint. Conclusions: Readmission is a significant problem which heralds a poor 12‐month prognosis.
TRANSURETHRAL RESECTION OF THE PROSTATE: STILL THE GOLD STANDARD
Authors: Gordon N. S. I. , Hadlow G. , Knight E. , Mohan P. 
Published: January 2008

Background: In recent times there has been a number of newer methods advocated as treatment for bladder outlet obstruction. Prior to embracing these newer technologies, the authors' experiences with conventional transurethral resection of the prostate should be evaluated and compared with those experienced in the newer modalities. The objective was to determine whether a standard transurethral resection of the prostate (TURP) still compared favourably with the newer modalities in terms of duration of stay, duration of catheterization, re‐admission rate, re‐catheterization rate, cost and long‐term results. The results are compared with those of workers whose level of expertise was the best that could be achieved with transurethral needle ablation (TUNA) and laser prostatectomy. Methods: During the 3‐year period from September 1992 to September 1995, 575 TURP were carried out in a regional hospital. The total duration of stay, the postoperative duration of stay, the re‐catheterization and re‐admission rates were assessed and the costs estimated. Results: Transurethral resection of the prostate was shown to compare favourably in terms of the duration of hospital admission and the duration of catheterization, and to have a significantly lower re‐catheterization rate and a significantly lower re‐admission rate than the newer modalities. Conclusion: Transurethral resection of the prostate is still the method of choice for surgical management of bladder outlet obstruction, and it remains as the gold standard. Having reviewed the results of the newer modalities as carried out by the experts in those fields, it was found that TURP compares favourably with those procedures. From the point of view of duration of stay, duration of catherization, re‐admission rate and re‐catheterization rate, as well as cost and long‐term results, TURP remains as the gold standard and the newer modalities are not believed to be advantageous at this stage.
HOW ACCURATE ARE REFERENCES IN THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY?
Authors: Kee Warwick D. Ngan , Roach Vijay J. , Lau Tze K. 
Published: January 2008

Background: The accuracy of reference citations in The Australian and New Zealand Journal of Surgery was evaluated. All of the references from 1995 (Volume 65) were included (n= 4092). Methods: A sample of 100 references was randomly selected and examined in detail by comparison with the original references. Results: Overall, 60% of citations contained errors. Errors were categorized by dividing references into six elements. A total of 38.8% of citations contained an error in one element, 15.6% contained errors in two elements, 4.4% contained errors in three elements, and 4.4% contained errors in four elements of the reference. The most common errors were errors of authors' names and errors in the title. Conclusions: Contributors to this journal should take more care in checking references in their manuscripts before publication.
A COMMUNITY‐BASED HOSPITAL EXPERIENCE WITH COLORECTAL CANCER
Authors: Platell Cameron 
Published: January 2008

Background: Survival figures for patients with colorectal cancer are often based on data from tertiary referral centres for colorectal surgery. The relevance of such data to community‐based hospitals is questionable. The aim of the present study was to determine the long‐term survival in patients presenting with colorectal cancer to a large community‐based teaching hospital. Methods: A search was conducted on the hospital computerized database to determine those patients who were admitted with a diagnosis of colorectal cancer between 1989 and 1994. These records were linked to the Deaths Registry to determine long‐term survival. Results: A total of 477 patients were managed at Fremantle Hospital over the 5‐year period. Nearly half of these patients (47.6%) presented via the hospital emergency centre. At diagnosis, 57.8% of patients had advanced cancers with either nodal or distant metastases. Surgery was undertaken on 455 patients, with a postoperative mortality of 4.5%. The corrected 5‐year survival rate for patients undergoing curative resections (i.e. complete local excision and no evidence of metastases) was 62.9% for colon cancers and 48.2% for rectal cancers. Local recurrence developed in 21.4% of patients with rectal cancers. Conclusions: A majority of patients with colorectal cancers are continuing to present with advanced disease. Earlier diagnosis of these cancers through community‐based screening programmes could well serve as an achievable solution to this problem.
COSMESIS FOLLOWING COMPLETE LOCAL EXCISION OF BREAST CANCER
Authors: Lindsey I. , Serpell J. W. , Johnson W. R. , Rodger A. 
Published: January 2008

Background: With the establishment of the safety of breast conservation in early breast cancer, cosmesis has become an increasingly important end‐point of treatment. The aim of the present study was to establish a model to assess breast cosmesis after complete local excision and to assess cosmesis achieved in patients who had surgery using the seroma technique. Methods: A total of 42 patients were retrospectively reviewed and assessed by independent clinical assessment by a surgeon, structured questionnaire and clinical photography. Results: A total of 86% of patients were rated by surgeon and patient as having a good or excellent cosmetic outcome. There was a high degree of concordance between independent clinical assessment and clinical photographic analysis. Conclusions: A model has been established for the assessment of breast cosmesis; the technique of seroma formation without reconstruction of the defect results in good or excellent cosmesis in the majority of patients.
HYPOTHERMIC ISCHAEMIA OF THE LIVER: A RE‐PERFUSION PHENOMENON
Authors: Bell Roger , Makin Gregory , Robbins Peter , Robertson Terry , House Anthony K. 
Published: January 2008

Background: The effects of hypothermic injury to the liver were investigated on an isolated perfusion circuit by comparing porcine livers with varying degrees of preservation injury. Methods: A group of unstored livers (n= 5) were compared to livers stored in University of Wisconsin (UW) solution for 18 h (n= 5), and a group of livers stored in Hartmann's solution for 18 h (n= 5). Results: We observed that the degree of platelet sequestration was directly related to the severity of the preservation injury. After 2 h of isolated liver perfusion, the perfusate platelet count fell from 148 ± 14 × 109/L to 84 ± 13 × 109/L for control livers. In comparison for livers stored in UW solution, the platelet count fell from 173 ± 43 × 109/L to 61 ± 14 × 109/L, representing a 64.8% fall, while for those stored in Hartmann's solution, an even more profound fall from 152 ± 36 × 109/L to 19 ± 9 × 109/L (87.5% fall) was observed. The difference between the UW‐stored and Hartmann's‐stored livers was significant (P < 0.05). However, using this model, the degree of leukocyte sequestration did not differentiate the groups. Both histological and ultrastructural examination of liver biopsies taken immediately following revascularization demonstrated that for mild degrees of preservation injury following hypothermic storage, changes occur to the sinusoidal lining cells well before changes to the parenchymal elements. Conclusions: These findings substantiate the hypothesis that the primary injury associated with hypothermia involves the sinusoidal lining cells (non‐parenchymal elements), that it is predominantly a reperfusion phenomenon and that efforts at improving preservation should therefore be targeted primarily at these cells and not the hepatocytes.
COMMUNICATING WITH PATIENTS: SURGEONS' PERCEPTIONS OF THEIR SKILLS AND NEED FOR TRAINING
Authors: Girgis Afaf , Sanson‐Fisher Rob W. , McCarthy William H. 
Published: January 2008

Background: This study assessed surgeons' current perceived level of competence in a number of interactional skills, their perceptions of the need for training and assessment in interactional skills, and their perceptions of the appropriateness of the format and content of two existing communication skills training packages. Methods: Of 267 surgeons who were sent the survey, 63% (n= 143) of eligible respondents completed and returned it. Results: More than three‐quarters of the sample identified the following skills as being important or very important in being a good surgeon: breaking bad news; preparing patients for surgical procedures; educating patients about their diagnosis and treatment, and increasing the likelihood that they will remember what they have been told; detecting anxiety and depression in patients, encouraging patients to express these and listening to their anxieties. More than half the sample felt at least competent at seven of the 10 interactional skills, but almost one‐third of the sample reported being ‘not or not at all competent’ at increasing patients' ability to remember what they have been told and at encouraging patients to express anxieties about their condition, and a further 13.3% reported a lack of competence at breaking bad news to patients about their diagnosis/prognosis. A higher proportion reported a lack of competence in providing bereavement counselling (59.6%), and gaining consent for organ donation (56.6%) and for autopsy (48.9%). The majority rated different aspects of the two communication skills training packages as either ‘good’ or ‘excellent’. Conclusions: The survey identified a number of communication skills which are perceived by surgeons to be important and to require formal training and assessment.
COLONIC J‐POUCH AS A NEORECTUM: FUNCTIONAL ASSESSMENT
Authors: Chew Sun‐Beng , Tindal Donald S. 
Published: January 2008

Background: Sphincter‐saving procedures are now commonly used for low rectal cancer but straight colo‐anal anastomosis seemed to produce poor functional outcome. The present study was therefore carried out to compare and contrast the functional outcome of colonic J‐pouch and straight colo‐anal anastomosis. Methods: The clinical and functional outcome of 17 patients having a colonic J‐pouch‐anal anastomosis and 10 patients having a straight colo‐anal anastomosis were compared. They were compared in terms of age, sex, distal resection margin, Dukes stage, histological grade, morbidity/mortality and postoperative anal function. Results: There was better bowel function in patients having J‐pouch‐anal anastomosis, especially in the early period after closure of the covering stoma. Bowel frequency in those patients who had a J‐pouch anastomosis was much less compared to those patients in the straight colo‐anal group in the 1st and possibly the 2nd year. There was a period of adaptation for the straight colo‐anal group which led to a bowel frequency approaching that of the J‐pouch group over 1–2 years. Differences in urgency, faecal continence, evacuation function, the use of drugs to slow bowel frequency and ability to discriminate between flatus and faeces were found to favour the J‐pouch group in the first postoperative year. The difference between the two groups diminished after that because the straight group improved, especially by the end of the 2nd year. During the study period, there were no constipation problems in the J‐pouch group, as noted in some other studies. This was probably associated with the 6‐cm length chosen for the pouch. Conclusions: The use of colonic J‐pouch resulted in a significant decrease in stool frequency and more satisfactory anal function for the first postoperative year. This difference lessened during the second postoperative year. There was no demonstrable difficulty with rectal evacuation in the pouch patients.
MANAGEMENT DEFICIENCIES AND DEATH PREVENTABILITY IN 120 VICTORIAN ROAD FATALITIES (1993–1994)
Authors: McDermott Francis T. , Cordner Stephen M. , Tremayne Ann B. 
Published: January 2008

Background: In 1992 a multidisciplinary committee was established to identify problems in the management of road fatalities in Victoria, Australia, to assess their contribution to death, and to identify preventable deaths (preventable: survival probability more than 75%; potentially preventable: survival probability between 25 and 75%). Methods: For 1993–94, 120 consecutive fatality cases surviving until arrival of ambulance services were evaluated by analysis and discussion of their complete pre‐hospital, hospital and autopsy records. Results: A total of 1175 problems were identified in 455 admissions to the various areas of care. A total of 949 problems (81%) were found to be management errors and 123 (11%) were found to be system inadequacies. Technique errors (35 (3%)), diagnosis delays (27 (2%)) and diagnosis errors (41 (4%)) were less frequent. The emergency department (ED) accounted for 662 (56%) problems, followed by 191 (16%) pre‐hospital problems and 140 (12%) intensive care unit (ICU) problems. There were 598 (51%) problems that were assessed as contributing to death. A total of 308 (52%) problems occurred in the ED, 106 (18%) were pre‐hospital problems and 71 (12%) occurred in ICU. Management errors comprised 465 (78%) problems contributing to death, and system inadequacies comprised 76 (13%) problems. Resuscitation problems accounted for 101 (40%) of the 254 ED management errors contributing to death. A total of 79 (66%) deaths were assessed as non‐preventable, five (4%) were assessed as preventable and 36 (30%) were assessed as potentially preventable. Conclusions: Organizational and educational countermeasures are required to reduce the high frequency of problems in emergency services and clinical management.
LONG‐TERM RESULTS OF INTRAMEDULLARY PINNING OF FOREARM FRACTURES IN A DEVELOPING COUNTRY
Authors: Wal Anton 
Published: January 2008

Background: Patients with fractured forearms who were treated with intramedullary Rush pinshails at Port Moresby General Hospital (Papua New Guinea) were studied. Methods: Sixteen patients were reviewed 24 months after insertion of the pinshails. Results: The results indicate that good outcomes could be achieved by the use of intramedullary pins in developing countries. There were no major specific short‐or long‐term complications (re‐fracture or non‐union). Disability in terms of pain and stiffness was noted in only three out of six patients with pins in situ. These were considered temporary disabilities. Conclusions: The pins are much cheaper than plates and screws, require minimal expertise for insertion, and removal was performed under local anaesthetic as outpatient cases. They remain a valuable method for managing patients with forearm fractures in developing countries.
LASER THERAPY FOR MULTIPLE BlLlARY PAPILLOMATOSIS VIA CHOLEDOCHOSCOPY
Authors: Meng W. C. S. , Lau W. Y. , Choit C. L. , Li A. K. C. 
Published: January 2008

Background: Multiple biliary papillomatosis is a rare tumour of the biliary tract but is capable of multicentric malignanttransformation. The complete removal of these tumours is difficult because it involves a field change of the biliary tract. Methods: Exploration with choledochoscopy is a prerequisite for thorough assessment of the extent of involvement. Incorporation of laser ablation via a laser‐delivering fibre with choledochoscopy permits complete removal of the tumour. Results:Repeated laser therapy via choledochoscopy through the T‐tube tract enables complete ablation of the tumour which changes the outlook of the prognosis. This is confirmed on subsequent cholangiography. Conclusions:Laser therapy via choledochoscopy is a satisfactory mode of treatment for multiple biliary papillomatosis. It enables complete and precise ablation of the tumour which certainly changes the prognosis of this condition.
BILE DUCT IMAGING AND INJURY: A REGIONAL AUDIT OF LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Merrie A. E. H. , Booth M. W. C. , Shah A. , Pettigrew R. A. , McCall J. L. 
Published: January 2008

Background: The aim of the present study was to report details of practice with respect to bile duct imaging and bile duct injury. Methods: A prospective audit of laparoscopic cholecystectomy (LC) was undertaken in the Otago region from the introduction of LC in 1991 through to December 1995. The audit includes all procedures done by all surgeons in public and private hospitals over the period without exclusion. Results: Laparoscopic cholecystectomy was attempted in 929 patients and completed laparoscopically in 832 (89.6%). Intra‐operative cholangiography (IOC) was undertaken with increasing frequency over the study period, from 5.9% in 1991 to 32.2% in 1995. The overall IOC rate for individual surgeons varied from 4.5 to 47.6%. The use of peri‐operative endoscopic retrograde cholangiopancreatography (ERCP) increased with the introduction of LC but has plateaued at ˜6%. A total of 15.4% of patients with one or more clinical indicators of choledocholithiasis underwent LC without any form of bile duct imaging. Eight main bile duct injuries (0.86%) and a further 18 bile leaks occurred (total bile duct injury rate 2.8%). Intra‐operative cholangiography was attempted (unsuccessfully) in only one patient with main duct injury, although five of the eight injuries were recognized intra‐operatively. Conclusion: This prospective regional audit demonstrates a gradual return to the use of IOC, a modest but stable reliance on peri‐operative ERCP, and a higher than expected rate of bile‐duct injury.
INTRAVESICAL THERAPY FOR THE TREATMENT OF NEUROGENIC BLADDER IN CHILDREN
Authors: Holland A. J. A. , King P. A. , Chauvel P. J. , O'Neill M. K. , McKnight D. L. , Barker A. P. 
Published: January 2008

Background: Oral pharmacotherapy has been commonly used as an adjunct to clean intermittent catheterization (CIC) in the treatment of neurogenic bladder in order to achieve continence, but may be associated with unacceptable side effects. The authors' experience with sterile intravesical preparations of oxybutynin hydrochloride and ephedrine in children is reported here. Methods: Patients requiring CIC for neurogenic bladder but with incontinence that was unresponsive to standard oral therapy or that was associated with severe systemic side effects were studied over a 1‐year period. Clinical, radiological and urodynamic assessments were made prior to commencing treatment with intravesical oxybutynin hydrochloride. Patients who remained incontinent with poor internal sphincter muscle tone had intravesical ephedrine added. Results: Seven patients were involved in the study over a 1‐year period. Two patients became continent and one patient had an improvement in upper tract dilatation. One patient had a limited improvement with oxybutynin alone but became continent with the addition of ephedrine. Three patients had no response to treatment. There were few side effects. Conclusion: Intravesical agents have a role in the management of paediatric neurogenic bladder for those children with significant adverse sequelae from oral pharmacotherapy who would otherwise require surgical intervention. Intravesical therapy is a safe technique in children with sterile preparations. Further investigation of this modality should be pursued.
WHERE THE SUN NEVER SHINES: ANORECTAL MELANOMA
Authors: Miller Brian J. , Rutherford Leigh F. , Mcleod G. Roderick C. , Cohen Jon R. 
Published: January 2008

Background:Melanoma occurring in the anorectal region is recognized to be an uncommon tumour with a poor prognosis. Queensland has the highest incidence rate of cutaneous melanoma in the world. The purpose of the present study was to determine if the very high incidence of cutaneous melanoma in Queensland has any bearing on the incidence of anorectal melanoma, and to compare this with published studies from other parts of the world. An assessment of the authors' results in the treatment of anorectal melanoma was made by a review of patients presenting during the last decade throughout Queensland. Methods: All cases of melanoma occurring in Queensland are accumulated in the Melanoma Register, administered by the Queensland Melanoma Project, and data from this were used to derive the results in the present study. Queensland population data were provided by the Australian Bureau of Statistics. Results:During the study period 1985–95 in Queensland there were 21 391 cases of cutaneous melanoma which occurred in an average population, during that time, of 2.89 million. During the same time there were nine cases of anorectal melanoma, giving a relative incidence therefore of 0.04%. This contrasts with published relative incidences of 0.2% for white people in North America, 11% for Southwestern Native Americans, and 14.2% for Northern Pakistan (P < 0.0001). However, the population‐based incidence rates of anorectal melanoma for Queensland, United States white people, Southwestern Native Americans and Northern Pakistan are not significantly different from each other. All patients in the present series presented with large tumours, and none survived beyond 25 months despite standard surgical and adjuvant therapy. Conclusions: The protection against cutaneous melanoma afforded by skin pigmentation is not apparent in the anal area. Anorectal melanoma is no more or less frequent in Queensland, even with the very high incidence rate of cutaneous melanoma. Sun exposure appears to be neither protective nor a risk factor. The outcome of therapy for this condition remains disappointing in the authors' experience.