bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE FASCIOCUTANEOUS ISLAND FLAP: AN EXTENSION OF THE ANGIOTOME CONCEPT
Authors: Behan F. C. 
Published: January 2008

The concept of the fasciocutaneous island flap (FCIF) has been established as a result of clinical experience in which over 180 cases have been compiled. It is a reconstructive design principle based on vascular and neural anatomy. Even though the flap pattern varies from region to region, it is the trilaminate composition of skin, fat and fascia supplied by fasciocutaneous, musculocutaneous and septocutaneous vessels, which is the basis for its success. Sometimes regional variations in this arrangement occur, for example: there is no deep fascia evident in the trigeminal nerve (CN‐V); and in the hand and the foot, the local vascular anatomy still supports this island flap idea without any defined fascial lining.Following their use in the head and neck region, and as more successful ones were designed, the flaps seemed to follow the circumferential layout on the trunk and the longitudinal distribution in the limbs, similar to the dermatomal markouts. Such dermatomal charts thus became the basis of unexplored flap potentials with or without axial vessels.In the past, the clinical word ‘angiotome’ (which means a vascularized segment) has been used in world literature to describe flap vasculature with axial input. Thus flaps with a fasciocutaneous basis may well be described as a fasciocutaneous angiotome.
DO MEDICAL STUDENTS REMEMBER MULTIPLE CHOICE QUESTIONS?
Authors: Miller Brian J. , Effney David J. , Gough Ian R. 
Published: January 2008

The values of pre‐testing senior medical students at the start of their surgical terms are the perception that they acquire of the scope of the subject and the extra practice they gain in the technique of sitting multiple choice question (MCQ) exams. The purpose of this study was to determine whether MCQ in a pre‐test that were repeated in a post‐test were answered more accurately than questions that had not been repeated.For the past 3 years at the University of Queensland, fifth year medical students have been voluntarily sitting pre‐ and post‐tests in each of the four surgical terms. Each examination consisted of 60 clinically orientated surgical questions of a difficulty appropriate for senior medical students. A total of 404 students did both the pre‐ and post‐tests during 1990 and 1991. The two examinations were carefully chosen for comparability. Of the 60 questions in each examination, 30 were repeated in the post‐test and 30 were fresh questions in the post‐test. The pre‐ and post‐tests were reversed for the second of the two years to increase consistency.There was a general improvement in the standard of results from the pre‐test to the post‐test. There was also a small improvement for the repeated questions compared to the non‐repeated questions (P < 0.0001).The authors conclude that the marked improvement of the post‐test compared to the pre‐test is mostly attributable to the students increasing their knowledge base through learning during their surgical term. To a much lesser extent improvement was also attributable to recollection of questions asked of them 6 weeks before, without specific tuition or information about the answers.
PNEUMOMEDIASTINUM FOLLOWING TRANSANAL EXCISION OF A RECTAL TUMOUR
Authors: Farmer K. C. R. , Tjandra J. J. , Hockenberry S. , Fazio V.W. 
Published: January 2008

A 45 year old male underwent full thickness transanal excision of a recurrent rectal villous adenoma. On the evening of surgery he developed an unexplained fever of 38.9°C. Plain X‐rays revealed a significant pneumomediastinum and pneumoretroperitoneum. This was thought to be due to passage of intrarectal air into the mesorectum and extravasation along tissue planes. The patient was managed with restricted fluids by mouth, an antidiarrhoeal agent, intravenous antibiotics, and frequent clinical and radiological observations. During the following 48 hours the fever settled and the pneumomediastinum resolved by the tenth postoperative day. Sigmoidoscopic examination at this time showed a healing rectal wound.This case illustrates a potential consequence of pelvic surgery and emphasizes the extent of the visceral space that exists as a continuum between the pelvis, abdomen, thorax and neck. This is an unusual complication with a dramatic radiological appearance, but one that can be managed successfully with expectation of a completely benign course.
FACTORS AFFECTING OUTCOME IN THE RESUSCITATION OF SEVERELY INJURED PATIENTS
Authors: Hill David A. , Abraham Kenneth J. , West Richard H. 
Published: January 2008

This is a retrospective, hospital based study of the resuscitative management of 40 consecutive, multitrauma patients (Injury Severity Score (ISS) > 2.5) admitted directly from an inner metropolitan environment over a one year period. The aim was to identify physiological, anatomical and time variables that correlated with an adverse outcome. Such information would facilitate the development of management protocols to improve future care.The clinical management of airways, breathing, circulation and head injury was reviewed in both the pre‐hospital and Emergency Department (ED) phases of care. Eleven patients died during the resuscitative phase, 10 from blood loss and one from head injury. Nine patients died during the definitive care phase, seven from head injury and two from multiple organ failure.Scene hypotension (systolic blood pressure 80 mmHg), ED Glasgow Coma Scale 9, ISS < 50, and Revised Trauma Score 4 were variables that correlated strongly with fatal outcomes. The median pre‐hospital time was 33 min for those hypotensive in the field. The median ED time was 70 min for hypotensive patients who went to operating theatres.Survival following severe trauma may be increased by avoiding secondary insults in head injured patients and improving the management of haemorrhagic shock. The time frame from accident to operating theatre should be kept under 90 min. Warmed blood, fresh frozen plasma and platelets should be used early in the resuscitation. An early move to definitive control of bleeding should accompany vigorous volume resuscitation.
TRAUMA AUDIT AND QUALITY IMPROVEMENT
Authors: McDermott Frank T. 
Published: January 2008

Audit is the evaluation of patient care. The care of the injured patient commences at the accident scene and involves prehospital triage and management, emergency hospital assessment and resuscitation, diagnostic and therapeutic interventions, operative surgery, intensive care unit management, acute hospital care and rehabilitation. Audit assesses the delivery of trauma care and clinical management and through identification of inadequacies facilitates the introduction of appropriate improvements.Both the American National Academy of Sciences—National Research Council and the Australian National Health & Medical Research Council have recommended the establishment of an audit process to evaluate the quality of trauma management and to obtain quality assurance. They have advised that this process would be assisted by the development of regional trauma registries and a uniform approach to the grading of injuries.Reduction in the preventable death rate, frequency of complications and duration of hospitalization has followed audits as a result of changes in the organization and quality of trauma care. In the United States, for example, the preventable death rate after injury was reduced from 35 to 15% in Orange County, California and from 14 to 3% in San Diego County, California. Studies from Great Britain, The Netherlands, Canada, Australia and elsewhere have further supported the view that trauma audit modifies practice leading to reductions in mortality and morbidity.
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Kent Alison L. , Cox Michael R. , Wilson Thomas G. , Padbury Robert T. A. , Toouli James 
Published: January 2008

Laparoscopic cholecystectomy is the preferred method of treatment for symptomatic choledocholithiasis. Since its introduction there has been an increase in postoperative diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to assess the indications and results of ERCP following laparoscopic cholecystectomy.Sixty‐one patients had an ERCP following laparoscopic cholecystectomy. Two broad groups were identified: Group 1 (35 patients) had filling defects (consistent with stones) noted on operative cholangiography, which were not successfully flushed or extracted at the time of laparoscopic cholecystectomy; Group 2 consisted of patients who developed problems following laparoscopic cholecystectomy. Nine patients had post‐laparoscopic cholecystectomy pain with abnormal liver function tests (LFT), four of whom had common bile duct (CBD) injuries and three had CBD stones. Eleven patients had post‐laparoscopic cholecystectomy pain with a normal diameter common bile duct on ultrasound and normal LFT; only one had a CBD stone. Five patients with a persisting bile leak following laparoscopic cholecystectomy had an ERCP and endoscopic sphincterotomy. In three the leak ceased, while two required subsequent open surgery to drain bile collections and ligate the cystic duct. One patient presented with an episode of transient jaundice but had a normal ERCP.There were six post‐ERCP complications; three patients had mild pancreatitis, two had a minor haemorrhage and one an asymptomatic duodenal perforation.Endoscopic retrograde cholangiopancreatography post‐laparoscopic cholecystectomy was most valuable for the management of retained stones and the diagnosis and management of post‐laparoscopic cholecystectomy pain in association with abnormal LFT. The diagnostic yield was low (9%) when the LFT were normal.
THE ECONOMIC COST OF ELECTIVE CAROTID ENDARTERECTOMY
Authors: Patel M. I. , Hardman D. T. A. , Fisher C. M. , Lane R. , Appleberg M. 
Published: January 2008

Cost awareness and accountability for the use of health care resources have become major issues for clinicians. In order to identify the economic costs associated with carotid endarterectomy (CEA), a retrospective review of 50 elective CEA between May 1993 and April 1994 was undertaken. Despite our belief [based on the Australian National Dingnostic Related Groupings (ANDRG)]. that our resource utilization had been retined to produce a median length of stay signiticantly below the New South Wales (NSW) State average, this study has identitied several areas of non‐productive expenditure. The mean cost of CEA per patient was $7053. This figure includes non‐productive expenditure of $793 per patient in the pre‐operative period and $395 per patient in the postoperative period. If these costs, which did not contribute to patient care. were removed the mean cost of CEA would be $5865.The major causes of non‐productive resource utilization included prolonged pre‐operative stay, duplicated or omitted investigations, as well as the use of the Intensive Care Unit for patient monitoring in the postoperative period.
SINGLE‐LAYER CONTINUOUS ANASTOMOSIS IN GASTROINTESTINAL SURGERY: A PROSPECTIVE AUDIT
Authors: AhChong A. K. , Chiu K. M. , Law I. C. , Chu M. K. , Yip A. W. C. 
Published: January 2008

Background: Single‐layer intestinal anastomoses have been constructed conventionally using an interrupted suture technique. It is, however, increasingly popular to perform such anastomosis using a continuous suture.Methods: One hundred and eighty consecutive patients with 254 continuous single‐layer anastomoses performed over a 4 year period were included in the study. Sixty‐one patients underwent oesophagectomy, oesophageal bypass or gastrectomy, 32 underwent biliary bypass, hepatic, biliary or pancreatic resection and 88 had colorectal operations. The median age was 67 years.Results: There were 254 anastomoses of which four leaked (1.6%). Fifteen patients (8.3%) died in hospital.Conclusion: These results show that the single‐layer continuous suture technique is safe in gastrointestinal anastomoses.
THE ROLE OF CORE BIOPSY IN THE DIAGNOSIS OF MAMMOGRAPHICALLY DETECTED LESIONS
Authors: Taft Rodney , Chao Ken , Dear Pat , King Catriona 
Published: January 2008

Background: Both stereotactic imaging and ultrasound have been used to localize non‐palpable breast lesions for core biopsy analysis. In particular, stereotactic core breast biopsy with a dedicated recumbent mammographic unit is an accurate and reliable technique, and this has been substantiated in a number of recent prospective studies comparing percutaneous core biopsy with open excisional biopsy.Methods: This article reviews biopsies of 521 lesions from 502 cases using both stereotactic localization (469 lesions) and ultrasound (33 lesions). The types of breast cancer and benign breast disease diagnosed with core sampling are reviewed. In this series it was not intended to compare all the results of core biopsies with those of open excisional biopsy, but a subset group, which comprised certain benign lesions and malignancies, as well as lesions diagnosed on core biopsy in which the radiology and pathology did not correlate, was further evaluated and compared to the findings with open biopsy. The cases where there were differences in core and excisional biopsy diagnosis are discussed.Results: In this series the benign to malignant ratio was 2.7:1; in other words, 27% of the lesions biopsied were malignant. The sensitivity for detecting cancer was 97% with the positive predictive value being 99%.Conclusions: This series further substantiates the accuracy of core biopsy. It is recommended that certain lesions diagnosed as benign on core biopsy histology should also proceed to open biopsy. Correlation between clinical findings, radiology and pathology further improves the reliability of core biopsy under imaging guidance.
SUSPECTED INTUSSUSCEPTION: IS ULTRASOUND A RELIABLE DIAGNOSTIC AID?
Authors: Wright J. E. , Slater S. 
Published: January 2008

Background: Infantile intussusception often presents with symptoms more common to less dangerous conditions, and diagnosis must be established as early as possible. Clinical diagnosis is often wrong and contrast enema is invasive. Sonography is painless and harmless and if it provides a reliable method of diagnosis or exclusion of intussusception, diagnosic delay will be avoided.Methods: In the John Hunter Hospital, Newcastle, between 1993 and 1994, the names of all children referred for abdominal sonography with a degree of suspicion of intussusception were recorded, and the histories were subsequently reviewed.Results: Fifty patients were studied. Forty‐one patients had no sonographic evidence of intussusception and nine patients had positive findings. None of the 41 patients who had negative sonograms proved to have intussusception. The nine patients who had positive findings were subjected to air enema. In two patients the sonographic diagnosis was proved wrong. In the other seven patients it was confirmed. Thus there were two false positives and no false negatives.Conclusion: Sonography is a reliable aid to the clinical diagnosis of intussusception.
ISCHAEMIC PRECONDITIONING OF THE LIVER: A PRELIMINARY STUDY
Authors: Hardy Kenneth J. , McClure David N. , Subwongcharoen Somboon 
Published: January 2008

Background: A phenomenon of ‘preconditioning’ exists for the heart, but has not been described for the liver. This study was undertaken to determine whether a brief episode of ischaemia (3 or 5 min) followed by a short reperfusion time (5 or 10 min) would precondition the liver to reduce subsequent injury from prolonged ischaemia (30 to 90 min).Methods: Male Wistar rats were allocated into five control (no preconditioning) and five preconditioned groups, each having a liver resection. The preconditioning times were 3 rnin ischaemia followed by 5 rnin reperfusion with a prolonged ischaemia of 60 or 90 min for the first two groups, and 5 min ischaemia followed by 10 rnin reperfusion with prolonged ischaemia times of 30 or 45 min for the other three groups.Results: Of rats resected with 3–5–60 rnin time sequence designed to assess survival, 9/10 died. However 9/10 died also in the matching control group with 60 rnin ischaemia. With a 5–10–45 rnin sequence, 9/10 survived more than 24 h in the preconditioned group and 1/10 in the non‐preconditioned controls. With a 5–10–30+ sequence designed to measure liver function tests, the prothrombin time was significantly improved; bilirubin, serum alkaline phosphatase and the alanine aminotransferase improved but these did not reach significance.Conclusion: A brief episode of ischaemia followed by an episode of reperfusion before a prolonged period of ischaemia ameliorated the effects of ischaemia‐reperfusion injury in a rat liver resection model. If hepatic preconditioning is confirmed in humans, ischaemic preconditioning will have an important role for all liver surgery.
EFFECTS OF LIVER TRANSPLANTATION AND RESECTION ON LIPID PARAMETERS: A LONGITUDINAL STUDY
Authors: Cooper Mark E. , Akdeniz Aysel , Hardy Kenneth J. 
Published: January 2008

Background: The liver plays a vital role in the production and clearance of a large number of lipoproteins and is an important determinant of the plasma levels of various lipids including cholesterol, as well as apoproteins such as apoprotein (a).Methods: To explore the role of the liver in the regulation of lipids and apoprotein concentrations, a serial prospective study measuring lipid parameters and apoprotein (a) levels over 6 months was performed in individuals undergoing hepatic resection for isolated hepatic metastases, transplantation for end‐stage liver disease and in individuals undergoing colorectal surgery for malignancy.Results: In the group with hepatic resection, there was a rapid decrease in total, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol in the immediate postoperative period. However, these changes could be explained by fasting and surgical intervention as a similar phenomenon was observed in the control subjects. In patients undergoing liver transplantation, total cholesterol decreased over the the immediate postoperative period but had fully recovered by day 40. Apoprotein (a) was low pre‐operatively, remained low over the first week but had risen by day 10. Apoprotein (a) at day 40 correlated with the apoprotein (a) level of the donor (r = 0.80, P<0.01) but not of the recipient's pre‐operative level and this correlation persisted 6 months after hepatic transplantation.Conclusions: The liver has a large reserve and is able to maintain lipoprotein production and removal despite greater than 50% removal. The major cause of reduced plasma lipid concentrations in the postoperative period relates to other factors such as fasting and handling of the gut during surgery. In liver transplantation, apoprotein (a) levels resemble those of the donor within 2 weeks of organ donation, consistent with the liver being the major site of production of this apoprotein.
IS PENETRATING INJURY ON THE INCREASE IN SOUTH‐WESTERN SYDNEY?
Authors: Sidhu S. , Sugrue M. , Bauman A. , Sloane D. , Deane S. 
Published: January 2008

Background: Few Australian studies describe the epidemiology of penetrating trauma. This study describes the incidence and demographic features of penetrating injuries with emphasis on trends and severity analysis.Methods: Case analysis was performed utilizing data from the Liverpool Hospital Trauma Registry (1989–94). NSW Department of Health Hospital Separations (1991–93), and the NSW Bureau of Crime Statistics (1991–93) with reference to the Liverpool and Fairfield Local Government Areas (LGA).Results: The Trauma Registry revealed 251 of penetrating trauma. The median age was 26 years (interquartile range 21–33). Ninety‐one per cent of the victims were male. Fourteen per cent of patients had an Injury Severity Score (ISS) > 15. Sixty‐five per cent of cases were stab injuries and 20% gunshot injuries with the abdomen being the most commonly injured site. Twenty‐one per cent of patients underwent laparotomy, 1.6% thoracotomy and 1.2% thoracotomy and laparatomy. There were 10 (4%) deaths. Trends in incidence of penetrating trauma and violent crime involving weapons were analysed. Static trends were observed for the annual incidence of penetrating trauma from the Liverpool Hospital Trauma Registry. Separations for penetrating trauma from Liverpool and Fairfield hospitals showed a slightly increasing trend. Violent crimes involving weapons in the Liverpool and Fairfield LGA showed a static trend. Nevertheless, separations for penetrating trauma and rates of violent crimes involving weapons were higher in south‐western Sydney than metropolitan Sydney or NSW. Eight per cent of the LGA population are Vietnamese but this study identified 16% of victims as being Vietnamese.Conclusions: This study found no significant increase in penetrating trauma or violent crime predisposing to penetrating injury in south‐western Sydney.
DIAGNOSIS OF BREAST CANCER WITH CORE‐BIOPSY AND FINE NEEDLE ASPIRATION CYTOLOGY
Authors: Poole G. H. , Willsher P. C. , Pinder S. E. , Robertson J. F. R. , Elston C. W. , Blamey R. W. 
Published: January 2008

Background: Patients who are elderly or who have locally advanced breast cancer may initially receive primary medical therapy.Methods: In order to avoid open biopsy in such patients, we routinely perform both fine needle aspiration cytology (FNAC) and core‐biopsy at the first clinic visit.Results: A retrospective review showed that of 109 such patients, 87 (80%) had the diagnosis confirmed on FNAC and 96 (88%) on core‐biopsy. Only eight patients did not have a diagnostic result from the first clinic visit, and five of these patients were diagnosed on a repeat core‐biopsy or FNAC. The remaining three patients had suspicious FNAC. Overall 97% had one or both investigations positive.Conclusions: When considered alone core‐biopsy was superior to FNAC. In this series the combined diagnostic approach of FNAC and core‐biopsy has allowed outpatient diagnosis for virtually all patients.
K‐RASMUTATION AND LOSS OF HETEROZYGOSITY OF CHROMOSOME 17P AND SURVIVAL IN COLORECTAL CANCER
Authors: Fung Caroline , Bragg Tara , Newland Ronald , Dent Owen , Nicholson Garth , BOKEY Lesley , Chapuis Pierre 
Published: January 2008

Background: The development of colorectal cancer (CRC) is thought to be a multistage process involving alterations to several types of genes, including oncogenes and tumour suppressor genes. This study examined the associations between allelic deletions of chromosome 17p in the region of thep53gene and K‐rasgene mutation and survival among CRC patients.Methods: Resected specimens from 233 patients were examined. Point mutation of codon 12 of K‐raswas assessed using a modified polymerase chain reaction method. Allelic deletion of 17p was demonstrated by loss of heterozygosity (LOH) with the marker Mfd144.Results: Fifty‐seven tumours (24%) showed somatic point mutation of codon 12 of K‐rasand 86 tumours (37%) showed LOH of Mfd144. There were 107 tumours (46%) with either K‐rasmutation or LOH and 18 tumours (8%) with both. Compared with patients with neither alteration, significantly poorer survival was experienced only by those with both alterations (P= 0.015). However, when this variable was introduced into a multivariate analysis controlling for the patient's age and tumour stage, it failed to show a statistically significant independent effect on survival.Conclusions: Point mutation of K‐rasand LOH of Mfd144 in CRC does not add to the prognostic information already available from clinicopathological staging.