bluuebunny/crossref_metadata_2025_split huggingface dataset:
PERCE THE PERMISSIVE PATHOLOGIST: A CAUTIONARY TALE OF ONE WHO MISDIAGNOSED A PSEUDOSARCOMA, KILLED THE PATIENT AND WAS FOUND OUT
Authors: Allen P. W. , Allen L. J. 
Published: January 2008

Perce, a promising young trainee pathologist, correctly recognizes a biopsy of a benign pseudosarcoma but his diagnosis is overruled by the less well read Head of Pathology. Acting under instructions from his Chief, Perce knowingly and without protest ‘signs out’ this benign condition as a sarcoma. The surgeon accepts the diagnosis without question and performs radical surgery, which is complicated by postoperative haemorrhage from which the patient dies. The Coroner orders a review of the slides and the misdiagnosis is discovered. Perce's defence that he did as he was told is rejected; he is forced to quit pathology and becomes an administrator.This unfortunate tale, which is related in verse, is intended to stress the importance of such benign but uncommon pseudosarcomas as nodular fasciitis, proliferative myositis, myositis ossificans, postoperative spindle cell nodule, pseudo‐ sarcoma of the bladder and juxta‐articular myxoma. The poem also implies that surgeons should not carry out radical surgery based on an uncommon pathological diagnosis without checking on the adequacy of consultation and informed review of the sections.
PRIMARY DUCT CLOSURE VERSUS T‐TUBE DRAINAGE FOLLOWING EXPLORATION OF THE COMMON BILE DUCT
Authors: Williams J. A. R. , Treacy P. J. , Sidey P. , Worthley C. S. , Townsend N. C. W. , Russell E. A. D. 
Published: January 2008

T‐tube drainage of the common bile duct (CBD) following duct exploration has become standard surgical practice. This randomized prospective study has compared primary closure versus T‐tube drainage of the CBD following exploration for calculous disease.Thirty‐seven patients underwent primary closure and 26 underwent closure over T‐tube. Both groups were comparable in terms of age, indications for surgery, associated illnesses, pre‐operative bilirubin, amylase and white cell count. Forty‐three per cent of operations were performed by a consultant in the primary closure group and 65% in the T‐tube group. There was no significant difference in the duration of operation, incidence of wound infection, surgical or other complications following operation between the two groups. However, the postoperative stay was significantly prolonged in the T‐tube group, to a median of 11 days, compared to 8 days in the primary closure group (P= 0.0001). This prolongation in stay was unrelated to whether admission was as an emergency or elective. T‐tube drainage of the bile continued for a median of 7 days postoperative, whereas the bile drained via a wound drain in only 13 (35%) of the primary closure group, for a median of 5 days in these 13 patients. Long‐term follow up was achieved in 48 patients, by a questionnaire sent at a median of 2.8 years following operation. Abdominal pains following recovery from the operation were experienced by 18% of the primary closure group and 20% of the T‐tube group. No patient developed jaundice or pancreatitis, nor needed further biliary surgery following operation. Primary closure of the CBD following exploration for calculous disease significantly reduces hospital stay, and is as safe as closure with T‐tube, in both the short and long‐term.
LAPAROSCOPIC LEFT ADRENALECTOMY: A NEW APPROACH
Authors: Robertson C. S. , Chung S. C. S. , Bouchier‐Hayes D. , Cockram C. S. , Li A. K. C. 
Published: January 2008

Left adrenalectomy has been performed previously via anterior, posterior, loin or thoracoabdominal approaches. In the classical transabdominal approach the left adrenal gland is resected following either mobilization of the spleen with the tail of the pancreas or after entering the lesser sac, mobilizing the inferior border of the pancreas off the adrenal gland.This report describes laparoscopic left adrenalectomy, in a patient with Conn's syndrome, performed by a new approach via the root of the left transverse mesocolon.
MYCOTIC CERVICAL CAROTID ANEURYSM
Authors: Naik D. K. , Atkinson N. R. , Field P. L. , Milne P. Y. 
Published: January 2008

Mycotic aneurysms of the extracranial carotid arteries are rare. with only 27 cases reported in the English literature.1 The causative organism is most frequently Staphylococus but infections due to Streptococcus, Salmonella and Klebsiella have been reported.2Escherichia coli has been reported as the causative organism in three cases. Mycotic aneurysms usually present in the setting of generalized sepsis such as postoperative infection, septicaemia. dental sepsis, drug addiction or bacterial endocarditis.We report a patient who presented with a mycotic aneurysm of the internal carotid artery 2 months after undergoing a laparotoiny for perineal sepsis.
THE INFLUENCE OF OTHER DISEASES UPON THE OUTCOME OF COLORECTAL CANCER PATIENTS
Authors: Payne John E. , Meyer Horst‐Joachim 
Published: January 2008

Little attention may be paid during follow up of colorectal cancer patients to other medical problems because the follow up is normally focused upon the diagnosis of recurrence and the detection of metachronous neoplasms. Attention directed at improving the medical condition of patients would be justified if it were shown that other diseases had a significant effect upon survival. Review of a selected consecutive series of 207 patients included collection of data about variables relating to demography, pathology, presentation, smoking, present and past health, performance, surgery, complications, length of stay, mortality, follow up and cause of death. Significance of relationships between medical and surgical problems and the outcome was determined by analyses of variation. Medical problems were present in 79% of patients; correlated with advancing age. Medical problems were not associated with complications, or with inpatient death. Previous cerebrovascular accident. dementia, limited mobility and increasing numbers of problems were associated with prolonged stay. Prolongation of stay, however, was related mainly to surgical complications.Smoking, which was present in 50% of patients, did not alter performance status, stage or substage, stay or survival significantly. Smoking and respiratory complications were associated significantly. Patients with heart or peripheral vascular disease had significantly poorer survival (P= 0.07) than those without those problems. Survival was reduced significantly for patients known to have diabetes, cardiovascular and cerebrovascular disease and limited mobility. Other malignant neoplasms were responsible for 18% of deaths which were unrelated to colorectal cancer. Residual or recurrent colorectal cancer had a more rapid adverse influence upon outcome than did medical problems. Attention to preventative therapy of cardiovascular disease during follow up might improve survival of patients who have resections for colorectal carcinomata.
THE DEVELOPMENT OF A TREATMENT PROTOCOL FOR PATIENTS WITH CHRONIC RADIATION‐INDUCED RECTAL BLEEDING
Authors: Chapuis P. , Dent O. , Bokey E. , Galt E. , Zelas P. , Nicholls M. , Yuile P. , Mameghan H. 
Published: January 2008

Backgrounds and Methods: This study reviews the clinical features and reports the preliminary results of treatment of 34 consecutive patients with clinically significant bleeding from chronic, radiation‐induced proctitis, using a combination of endoscopic YAG Laser and the application of topical formalin dressings to the rectal rnucosa.Results: Bleeding ceased in 25 patients (74%); bleeding continued but occurred only slightly and occasionally in five patients (15%); and three patients required operation to control the bleeding (9%). One patient relapsed after treatment and died while receiving a further transfusion.Conclusions: This experience has been used to develop a management protocol for patients with this serious complication.
A REVIEW OF PATHOLOGY REPORTING FOR BREAST CANCER
Authors: Wijetunga L. H. Raj , Carmalt Hugh L. , Gillett David J. 
Published: January 2008

Background: A detailed pathology report is important in the determination of treatment options and prognosis in breast cancer. Australia's first National Cancer Consensus Conference, held in 1994, recommended guidelines for the standardization of the clinical information to be provided to the pathologist, the specifications relating to the handling of specimens, and the resultant pathology report.Methods: We examined the current status of pathology reporting in invasive breast cancer in three New South Wales hospitals from 1986 to 1994.Results: Histopathologic type was documented in 99% of reports, grade was documented in 47%. size in 46%. and lymph node status in 98%. Only 27% of pathology reports reviewed documented the status of all the above parameters in the one report. Other features such as lymphatic and vascular invasion were documented in only 21% and 9% of pathology reports, respectively, while sex steroid receptor status was reported in almost 90% of cases.Conclusions: In view of the wide range in the percentage of features reported, we recommend the use of a standardized checklist for the pathological assessment of surgically resected invasive breast cancer specimens.
FUNDOPLICATION IN CHILDREN: EXPERIENCE WITH 106 CASES
Authors: Spillane A. J. , Currie B. , Shi E. 
Published: January 2008

Background: Gastro‐oesophageal reflux (GOR) is a physiological problem in infancy that can become pathological and life‐threatening in certain cases. Fundoplication has been shown previously to be effective in the control of this problem when medical therapy fails.Methods: A retrospective review of the hospital records and the Department of Paediatric Surgery database was carried out, in order to demonstrate the Prince of Wales Children Hospital's (POWCH) experience with 106 fundoplications between February 1989 and March 1993.Results: There was a failure rate of 7.5% and a long‐term mortality rate of 7.8%. The children most at risk of mortality and morbidity are shown to be the neurologically impaired. The special problems associated with these children as compared with neurologically normal children with pathological GOR are discussed and the literature reviewed.Conclusion: Fundoplication is shown to be a safe operation that can be life‐saving in certain circumstances.
GASTRIC CANCERS IN SINGAPORE: POOR PROGNOSIS ARISING FROM LATE PRESENTATION
Authors: Koong H. N. , Chan H. S. , Nambiar R. , Soo K. C. , Ho J. , Ng H. S. , Ng E. H. 
Published: January 2008

Background: Mortality rates from gastric cancer, apart from those derived from Japanese series, remain poor. This paper sought to determine the present outcome of gastric carcinoma in a predominantly Chinese population in Singapore. Prognostic factors useful in predicting survival were also evaluated in this population. Method: All cases of histologically confirmed gastric adenocarcinoma presenting in 1992 were entered into a prospective database. Prognostic factors related to age, sex, site of disease, depth of invasion, histological grade, nodal status and stage of disease were evaluated in patients with resectable disease to determine their utility in predicting survival. Results: Of 1310 consecutive patients with histologically proven adenocarcinomas, 37% had distant metastases at presentation predominantly in the liver (21%) and peritoneal cavity (20%). Sixty‐four per cent of patients underwent surgery and in only 51% of these patients was resection of the turnour possible. Stages 111 and IV (T4N2) locally advanced disease were present in 38% of patients. Thus the majority of patients presented with late or metastatic disease (75%, stages 111 and IV). Sixty per cent of patients were alive at I year and 40% at 2 years after resection of the tumour (Kaplan‐Meier survival plots). In contrast, no patient survived longer than a year if the tumour was not resectable (P < 0.001, log‐rank test). Median survival of patients without surgery was 12 weeks. Median survival for patients with resected stage IV disease was 23 weeks, compared to 18 weeks after surgical bypass. Age, sex, site, depth of invasion and histological grade did not significantly predict survival. Patients with node‐negative disease survived longer (2 year, 70%) than those with nodal involvement (2 years, 44%; P = 0.06, log‐rank test). Pathologic staging with the TNM system was useful in predicting survival (P < 0.001). Sixty per cent of patients with stage I and II disease were alive at 2 years compared to 54% with stage III disease and 0% with stage IV disease. Conclusion: The prognosis of stomach cancer remains poor, due predominantly to late presentation. Pathologic TNM staging and nodal status were useful in predicting survival outcome after resection. If the tumour were resectable, survival was appreciable even in patients with advanced stage III (2 years, 54%) and stage IV (1 year, 40%) disease. Strategies to improve outcome should focus on early detection of gastric carcinomas.
EARLY CLINICAL EXPERIENCE WITH CONTINENT URINARY DIVERSION
Authors: Millard Richard J. , Wang Yoncjin 
Published: January 2008

Background: Alternatives to cutaneous diversion have included continent urinary diversion and replacement cystoplasty. Fiveyear experience with continent diversion is reported. Methods: Between 1989 and 1994. 29 patients underwent continent urinary diversion. Of these, 24 patients underwent Indiana pouch procedures and five patients had a Mitrofanoff‐type procedure. All have now been followed up for at least 12 months. Results: The continence rate for the Indiana pouch group was 23/24 (96%) and the mean capacity was 648 mL (range 300–1400). There were nine (37.5%) early postoperative complications, only three of which (12.5%) required surgical revision. The late complication rate was 35.5% (7/22), and 18.2% (4/22) of the patients underwent re‐operation. Stomal stenosis occurred in two patients in whom the stoma was situated in the right iliac fossa, whereas all 12 stomas sited at the umbilicus had no stomal problem. Four of the five patients having Mitrofanoff procedures were continent, but these patients had higher rates of early and late complications. Conclusions: From this experience, the Indiana pouch urinary diversion appears to be superior to the Mitrofanoff procedure when continent diversion is indicated. An umbilical stoma site is optimal.
SUTURE HAEMORRHOIDECTOMY: A DAY‐ONLY ALTERNATIVE
Authors: Patel Nirmal , O'Connor Terence 
Published: January 2008

Background: Haemorrhoidectomy is a common treatment for third degree symptomatic haemorrhoids. and day surgery has increased because of increasing pressure for hospital beds. The aim of the present study is to describe a technique of suture haemorrhoidectomy (SH), conducted as a day‐only procedure, and compare the effectiveness and outcomes of this method with the conventional Milligan‐Morgan haemorrhoidectomy (MMH).Methods: The results of 18 consecutive patients, mean age 52 years (31–73) undergoing SH between April 1994 and June 1995 were compared with a historical control group of 17 consecutive patients, mean age 45 years (29–72). who had MMH in the preceding year. Seven patients were excluded because of intercurrent anal pathology (1), thrombosed haemorrhoids (1) or loss to follow‐up (5). An interviewer followed up patients using a telephone questionnaire.Results: Mean follow‐up was 6 months in the SH group and 18 months in the MMH group. There was no significant difference in total operative time. The SH group had a significantly shorter mean time to first void of 3 h versus 11 h (P < 0.005). mean time to first bowel action of 11 h versus 48 h (P < 0.005) and mean in‐hospital stay of 10 h versus 77 h (P < 0.005). The SH group had a significantly decreased linear analogue pain scale, a mean of 1 versus 3 (P < 0.05). The complications were: two readmissions for pain relief in the SH group and urinary retention in one MMH patient. None of the study group have had recurrence of haemorrhoids.Conclusion: Suture haemorrhoidectomy as a day‐only procedure is safe, less painful and reduces in‐hospital admission time. The long‐term effectiveness and complications of the technique are as yet undetermined.
A PROSPECTIVE AUDIT OF SELECTIVE CHOLANGIOGRAPHY FOR LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Jorgensen J. O. , Norman S. L. , Hunt D. R. 
Published: January 2008

Background: With the introduction of laparoscopic cholecystectomy (LC) there has been a reduction in the use of operative cholangiography. The practice of selective cholangiography (SC), where the common bile duct (CBD) is imaged only in those patients where the surgeon believes there is a significant risk of CBD stones has contributed to this reduction. Selective cholangiography has been criticized by advocates of routine cholangiography who argue that there will be more CBD stones missed and more CBD injuries.Methods: This prospective study reports the outcome in a series of 457 patients who had LC performed between 1990 and 1992 where cholangiography was used according to a strict protocol relying on clinical history, CBD size and pre‐operative liver function tests. There were no CBD injuries. Twenty‐nine patients (6.4%) had CBD stones.Results: Follow up by structured questionnaire at 12–24 months detected 6 patients (1.3%) with CBD stones. Three of these 6 patients had cholangiograms. Of the 3 patients with missed stones and no X‐ray, 2 were protocol breaches and only I patient from 307 (0.3%) with no indication for SC was subsequently found to have a CBD stone.Conclusion: We believe that this study validates a policy of SC.
MODIFICATION OF GROWTH OF DESMOID TUMOURS IN TISSUE CULTURE BY ANTI‐OESTROGENIC SUBSTANCES: A PRELIMINARY REPORT
Authors: Serpell Jonathan W. , Paddle‐Ledinek Joanna E. , Johnson William R. 
Published: January 2008

Background: Tamoxifen and toremifene have been used in patients with advanced desmoid tumours with response rates of 51%. Method: We developed an experimental model of desmoid tumour cells in tissue culture to study their effect. Four cell lines were established in tissue culture. All native and corresponding cultured tumours were oestrogen receptor negative. Tumour I was from a 22 year old with familial adenomatous polyposis (FAP) and recurrent abdominal wall desmoid turnours. She remains disease free on tamoxifen 4 years following surgery. Both her mother and sister also have shown regression of their FAP‐associated desmoid tumours at the menopause and on tamoxifen, respectively. We assessed the effect of tamoxifen on desmoid tumours in tissue culture at 780 ng/mL. The results were assessed by cell density counting. Results: Tumours 1 and 2 have responded with an approximately 50% reduction in growth to tamoxifen at 780 ng/mL. Conclusions: This apparent growth inhibitory effect of tamoxifen on two desmoid tumour cell lines appears to be independent of oestrogen and correlates with the in vivo effect of tamoxifen on three desmoid tumours in an FAP family.
INTERACTIVE UROLOGY AN EVALUATION
Authors: Khadra Mohamed H. , Guinea Ana I. 
Published: January 2008

Background: Interactive Urology is a multimedia software program that has been written to provide computer‐assisted interaction for medical students at the University of Sydney during their surgical term in urology. An evaluation sought to establish how the software will be used by medical students in the learning context and to explore the efficacy of the software in the transfer of content as well as problem‐solving skills. Methods: Interactional analysis during student computer sessions and pre‐ and post‐testing included a total of 80 medical students to evaluate Interactive Urology. Results: The software package appeared to promote higher‐order thinking skills with brainstorming activities occupying about half the time available. Utilizing pre‐ and post‐testing, Interactive Urology was found to be efficacious in the transfer of content and problem‐solving skills. It was also found to be as effective as text in transferring content and problem‐solving skills. The sequence of text and computer assisted learning (CAL) did not alter learning efficacy. Conclusion: It was concluded from the present study that Interactive Urology is an effective and valuable learning resource for medical students.
DOES THE COLON ADOPT SMALL BOWEL FEATURES IN A SMALL BOWEL ENVIRONMENT?
Authors: King David R. , Anvari Mehran , Jamieson Glyn G. , King John M. 
Published: January 2008

Background: Isoperistaltic colon interposition is one of several surgical options available in the treatment of short bowel syndrome. It functions primarily by slowing the rapid intestinal transit that follows small bowel resection (SBR). Previous studies have interposed distal colonic segments and although there is evidence of adaptation by the interposed colon it is not known whether these segments develop histologic or functional small bowel characteristics.Methods: In this study evidence was sought of metaplasia in the interposed segments after 80% SBR and, because proximal colon is a midgut derivative, the differences between proximal and distal colonic segments were examined.Results: There was no qualitative histological evidence of metaplasia by the interposed segments. There was a significant increase in crypt depth, mucosal thickness and maltase concentration of the interposed segments compared with the non‐transposed colon of the controls. The maltase concentations were increased to the extent that they were not significantly different from the concentration present in normal ileum.Conclusions: Although there was no gross evidence of small bowel intestinalization by the interposed segments, there was evidence of adaptation which was not merely an extension of the adaptive process seen after SBR alone. These changes resulted in the colon taking on some small bowel features. There was no significant difference between proximal vs distal interposed segments.
INTRALUMINAL BRACHYTHERAPY IN BILE DUCT CARCINOMAS
Authors: Leung John , Guiney Michael , Das Ram 
Published: January 2008

Background: Cholangiocarcinoma of the biliary tract is a rare tumour which has been treated with surgery, radiotherapy, chemotherapy, bypass procedures and stenting. Surgery remains the only curative treatment for these tumours, but a large proportion are unresectable. Intraluminal brachytherapy has been reported as an effective treatment for localized cholangiocarcinoma of the biliary tract. The purpose of our study was to analyse the survival of patients with biliary tract carcinoma treated with iridium‐192 brachytherapy.Methods: A retrospective review of patients treated at Peter MacCallum was undertaken. From 1989 to 1994, 16 patients underwent brachytherapy via a transhepatic approach for cholangiocarcinoma. There were 12 male and four female patients. The median age was 65 (range 40–83). All patients had cholangiocarcinoma. Prior treatment included complete resection in three, partial resection in one, bypass procedures in eight, endoscopic stents in five and external biliary drainage in 15 of the 16 patients. One patient had received external beam irradiation.Results: The median survival was 23 months and 61% survived 1 year. The most common acute complication was cholangitis seen in four patients and the most common late complications were duodenal ulcer seen in two patients and cholangitis seen in two patients.Conclusions: We conclude that iridium‐192 brachytherapy is a safe effective treatment for biliary tract carcinoma but a comparison between surgery and stenting would be of value. However, the cost of brachytherapy is not cheap and its value in this regard should be carefully analysed.