bluuebunny/crossref_metadata_2025_split huggingface dataset:
CELLULITE AND THE OCCULT DIABETIC
Authors: Harris Richard A. , Hardman David T. A. , Brown Alastair R. 
Published: January 2008

Background: Occult diabetes may be an important factor in the development of cellulitis and cellulitis may act as a precipitant to the diagnosis of diabetes mellitus. The present study defines the prevalence of diabetes and glucose tolerance impairment in a group presenting with cellulitis to a teaching hospital. A description of the demographic and pathological presentation of the group is undertaken.Methods: Five hundred consecutive admissions for cellulitis to a Sydney teaching hospital were analysed. The cases presented between 1985 and 1994. Precipitating factors, length of stay, site of infection, white cell count, degree of fever, blood sugar estimation, history of diabetes mellitus and microbiological diagnosis were recorded.Results: Forty‐nine patients had a prior diagnosis of diabetes mellitus. Twenty‐one per cent of patients (56/265) were noted to have abnormal glucose tolerance on routine testing. Thirty‐seven per cent of the 1994 cohort (14/38) demonstrated abnormal glucose tolerance. The most common precipitant was trauma (137/500). Mean length of stay was 8.7 days. Microbiological diagnosis was made in 32% of cases.Conclusions: Cellulitis requiring admission to hospital is a significant problem in terms of cost and bed occupation. A presentation with cellulitis may be a clinical indicator of impaired glucose tolerance. All patients presenting with cellulitis should have a fasting blood sugar level determined as part of routine workup.
LONG‐TERM EXPERIENCE WITH SCLEROTHERAPY FOR TREATMENT OF EPIDIDYMAL CYST AND HYDROCELE
Authors: Braslis K. G. , MOSS D. I. McL. 
Published: January 2008

Background: Symptomatic testicular hydrocele and cyst of the epididymis may be treated with either operation or sclerotherapy.Methods: The current report presents the experience of a 9 year prospective study using sodium tetradecyl sulphate (STD) sclerotherapy for the treatment of symptomatic hydrocele and/or epididymal cyst.Results: A total of 102 lesions were treated during the study period, with an initial success rate of 76% which improved to 94% with multiple treatments. The overall median follow up during the study was 30 months (range 2–100).Conclusions: Sclerotherapy offers a cost‐effective outpatient method for the treatment of symptomatic scrotal cysts.
INCOMPLETELY EXCISED BASAL CELL CARCINOMA: A MANAGEMENT DILEMMA?
Authors: Sussman L. A. E. , Liggins D. F. 
Published: January 2008

Background: Reported recurrence rates for incompletely excised basal cell cancers (BCC) vary widely (30–67%). and the destructive potential of recurrent BCC is well known. When surgically treated BCC are reported by the pathologist as incompletely excised the surgeon is placed in the dilemma of whether to perform an immediate wider excision, or to reserve further treatment until there is clinical evidence of recurrence. The aim of the present study is to determine if there are any clinical or morphological features which may help in this management dilemma.Methods: Middlemore Hospital histology records were reviewed. In 1986, 82 out of a total of 723 BCC excised were reported to be incompletely excised. The management and recurrence rates of the incompletely excised BCC were determined from the patient records and telephone follow up where necessary. The clinical and morphological features were correlated with the recurrence rates, with the aim of developing a management strategy.Results: The overall recurrence rate was 30.0%. Median time to recurrence was 18.5 months (range 1.5–55 months). Neither the margin of incomplete resection (deep, lateral or both margins), the site of tumour, the histological variant, the sex of the patient, nor prior treatment had any discernible effect on recurrence rates.Conclusions: Observation is an acceptable management option in most situations, as only one‐third of incompletely excised lesions needed further treatment. Most recurrences occurred early and careful follow up of these patients was indicated for at least 3 years.
MANAGEMENT OF SEMINOMA OF THE TESTIS: RECOMMENDATIONS BASED ON TREATMENT RESULTS
Authors: Morgan Graeme , Leong Trevor , Berg Derek 
Published: January 2008

Background: The results of management of seminoma of the testis at the Department of Radiation Oncology St Vincent's Hospital, Sydney were evaluated retrospectively to: (i) establish that outcomes were in keeping with published results from centres in Australia and overseas; (ii) assess the impact of chemotherapy on management; and (iii) to determine ‘best practice’ management protocols based on our results and a review of the relevant literature. Methods: (i) Assessment of treatment results for stage I and II seminoma of the testis treated by post‐orchidectomy radiotherapy and/or chemotherapy at St Vincent's Hospital between 1979 and 1993; (ii) literature review of published data from Australian and overseas centres on the management of seminoma of the testis, and in particular the use of surveillance or chemotherapy either alone, at time of relapse or combined with radiotherapy; and (iii) development of recommendations for use as management protocols in our department. Results: Our data and a review of the literature suggest that post‐orchidectomy radiotherapy with chemotherapy for relapse in stage I and IIA disease results in long‐term cure rates approaching 100%. Treatment with chemotherapy either routinely or selectively or using a surveillance policy is unlikely to show any improvement in outcome and may be less cost‐effective and/or produce increased morbidity and the risk of secondary leukaemia. For stage IIB disease (5–10 cm) the use of initial combination chemotherapy with or without subsequent radiotherapy did not appear to give better outcomes than initial radical radiotherapy alone, reserving chemotherapy or further radiotherapy for relapse. For bulkier stage IIB disease (> 10cm). the use of initial chemotherapy plus consolidation radiotherapy appeared to be an appropriate treatment. Conclusions: Management protocols for seminoma of the testis at St Vincent's Hospital, Sydney Department of Radiation Oncology currently are (i) stage I, IA and IIB (5–10 cm): post‐orchidectomy radiotherapy alone with chemotherapy or further radiotherapy for relapse; and (ii) stage IIB (> 10 cm) disease: initial chemotherapy post‐orchidectomy followed by radiotherapy to sites of initial disease involvement.
A CRITICAL EVALUATION OF FREE PAPER ABSTRACTS ACCEPTED FOR THE 1996 RACS ANNUAL SCIENTIFIC CONGRESS
Authors: Usatoff V. , Waxman B. P. 
Published: January 2008

Background: Abstracts form a major part of medical information dissemination and a measure by which papers are accepted for meetings. Concerns have been raised about the quality of abstracts presented to the Annual Scientific Congress (ASC) and second, about the validity of the term ‘scientific’ to describe this meeting. Methods: A critical evaluation was made of all free paper abstracts in general surgery from the ASC 1996, using a standard assessment process. They were judged on presentation and content. A direct comparison was made to the content of abstracts from the Surgical Research Society of Australasia 1995(SRSA) meeting. Results: The ASC abstracts scored 87% (6.1/7.0) for presentation but with clear deficiencies. The score of 49% (7.4/15.0) for the content of the ASC abstracts was significantly less than the score of 65% (9.8/15.0) that was attained by the SRSA abstracts when assessed on content. (Wilcoxon rank sum test, P < 0.000002.) Conclusions: The quality of the presentation of abstracts was adequate but could clearly be improved, especially with regard to the specific instructions to authors. The ASC abstracts were significantly less scientific in content that those of the SRSA abstracts. The criteria used to select abstracts for the ASC should be reviewed and the title of the annual College meeting should be reconsidered.
FOURTH BRANCHIAL SINUS CAUSING RECURRENT CERVICAL ABSCESS
Authors: Burstin P. P. , Briggs R. J. S. 
Published: January 2008

Background: Three patients who presented with recurrent cervical abscesses were found to have a branchial sinus arising in the piriform fossa. Each patient had previously had cervical abscess drainage procedures.Methods: A retrospective review of patients with recurrent cervical abscess and associated fourth branchial sinus was carried out.Results: In each case, imaging and endoscopy identified a sinus tract from the left piriform fossa. Neck exploration with hemithyroidectomy and excision of the sinus tract was performed without further recurrence of abscess.Conclusions: We believe these cases to represent a fourth branchial sinus. The relevant embryology and anatomy of the branchial apparatus is discussed and the pathways for the sinus and fistulous tracts of branchial sinus origin are reviewed. Branchial sinuses are uncommon, but should be considered as the underlying aetiology in patients who present with recurrent cervical abscesses.
GASTROINTESTINAL LAVAGE REDUCES TOTAL BODY WATER
Authors: Buckland Garry H. , Elbourne Ian , Crowe Philip J. 
Published: January 2008

Background: The aim of this study was to measure changes in total body water (TBW) in surgical patients after gastrointestinal lavage.Methods: In a prospective, controlled study we used bioelectrical impedance to calculate the change in TBW in two groups of general surgical patients in the pre‐operative period: the colonic lavage group consisted of patients fasted overnight who received 3 L of gastrointestinal lavage solution (GLS;n= 30), and the control group consisted of patients fasted overnight only (n= 30). Total body water was measured before and after either lavage and fasting (lavage group) or fasting alone (control group).Results: The lavage group had a mean TBW loss of 729 mL ± s.e. 217 and the control group a mean loss of 84 mL ± s.e. 93 (P< 0.01 unpairedt‐est).Conclusions: The results suggest that GLS results in a net loss of TBW. Although this fluid loss is modest, it may be important in surgical patients who have minimal cardiovascular reserve.
FRACTURED NECK OF THE FEMUR (DRG 210/211): PROSPECTIVE OUTCOME STUDY
Authors: Turner Peter , Cocks John , Cade Richard , Ewing Hamish , Collopy Brian , Thompson Graeme 
Published: January 2008

Background: An ageing population will increase the need for resources to treat patients with a fractured neck of femur (DRG 210/211). Provision of these resources will be helped by a better understanding of current practices. Methods: A prospective study of outcome at discharge for 100 consecutive patients with DRG 210/211 was conducted at five Victorian metropolitan teaching hospitals to assess length of stay and the reasons for any variations. Results: The major influences on timing of discharge were: delayed availability of rehabilitation beds; the timing of referral and assessment by the Geriatric Assessment Team; delay in surgery more than 24 h after admission; and development of postoperative complications. Conclusion: The efficient management of patients with DRG 210/211 requires a strong protocol of treatment and referral strategies with adequate resources.
POST‐CHOLECYSTECTOMY EXTERNAL BILIARY FISTULA
Authors: Singh V. , Kacker L. K. , Sikora S. S. , Saxena R. , Kapoor V. K. , Kaushik S. P. 
Published: January 2008

Background: External biliary fistula (EBF) following bile duct injury is a serious complication of cholecystectomy. Methods: From January 1989 to December 1994, 37 patients with post‐cholecystectomy external biliary fistula were seen at this centre. There were 14 partial, 22 complete and one sub‐vesical duct of Luschka injury. Sixteen patients had a controlled EBF at presentation; 10 patients had intra‐abdominal collections and seven patients presented with peritonitis. Results: A staged approach to the management of these patients was adopted in which the initial management aimed at creating a ‘controlled’ fistula. This approach comprised conservative treatment (n= 9), percutaneous catheter drainage of intra‐abdominal collections (n= 10), biliary drainage (n= 6), and surgical intervention (n= 7). One patient died because of progressive liver failure in spite of intensive management. Definitive management comprised the surgical repair of biliary strictures wherever indicated, after waiting for the acute problems to settle.Conclusions: By adopting a staged approach along with a judicious use of endoscopy, radiology and surgery that were based on clinical circumstances, it was possible to achieve satisfactory results for this otherwise distressing condition.
OPEN VERSUS CLOSED SURGICAL TREATMENT OF ABSCESSES: A CONTROLLED CLINICAL TRIAL
Authors: Abraham Ned , Doudle Mark , Carson Phil 
Published: January 2008

Background: Conventional drainage, curettage and packing of acute superficial abscesses has been challenged and in some centres replaced by curettage and primary closure under antibiotic cover. This technique has not been used widely in Australasia or North America, probably because of the lack of reassurance from local randomized trials. Methods: A randomized trial was conducted to compare the primary closure of acute superficial abscesses to conventional packing. Abscesses requiring drainage under a general anaesthetic were considered for the study, excluding extensive, secondary and deep suppurations. In the ‘open’ group, the abscess was drained, curetted, irrigated, and then packed. Instead of packing, the cavity in the ‘closed’ group was obliterated using interrupted vertical mattress skin sutures with/without closed suction drainage. Other aspects of management were standardized. Results: Of the 32 abscesses treated using the closed technique, 25 (78%) healed by primary intention after 1 week (SE(p) = 7.3%; 95% CI = 63.7–92.4%). One of the 29 abscesses (3%) treated using the open technique healed by secondary intention in a similar period of time. The difference was statistically significant (Chi‐squared test with Yates' continuity correction = 31.70; P < 0.0001). There was no statistically significant difference in the overall incidence of healing, 1 month after surgery (χ21= 0.07; P > 0.9). In the closed group, healing was obtained by primary intention, leaving a linear surgical scar in 84% of the cases (SE(p) = 5.7%; 95% CI = 72.8–95.2%). Hospitalization and the need for analgesia and dressing changes were reduced by 40–60%. Conclusions: Primary closure of acute superficial abscesses was associated with an improved outcome in terms of duration and quality of healing, postoperative pain, length of hospitalization, nursing care and, by implication, cost, and may be recommended as an alternative treatment that is superior to the orthodox technique.
THORACOSCOPIC VAGOTOMY FOR RECURRENT ULCER AFTER PREVIOUS GASTRIC OPERATION
Authors: Poon Ronnie , Chow Louis , Lim Boon , Gertsch Phillip 
Published: January 2008

Background: Recurrent peptic ulcer after previous gastric operation is a difficult surgical problem and abdominal re‐operation is associated with significant morbidity, mortality and recurrence rate. Methods: The authors report on five patients with recurrent ulcers who, after previous gastric operation, were treated with thoracoscopic vagotomy. Results: All patients tolerated the procedure well without complications, and the median hospital stay was 5 days. Endoscopy confirmed healing of the ulcers in all patients. Pre‐operative and postoperative gastric acid studies showed a significant postoperative reduction in both basal and maximal acid output (P < 0.05). In a follow‐up period of 18–33 months, one patient had a recurrent ulcer presenting with bleeding. Gastric biopsy revealed presence of Helicobacter pylori and repeated gastroscopy after a course of H. pylori eradication treatment showed a healed ulcer. The other four patients were asymptomatic. Conclusions: We conclude that thoracoscopic vagotomy is a simple and safe procedure for the treatment of recurrent ulcers after previous gastric operation, but the long‐term results need further assessment.
OMENTAL TRANSPOSITION FLAP FOR GROSS LOCALLY RECURRENT BREAST CANCER
Authors: Cheung K. L. , Willsher P. C. , Robertson J. F. R. , Bailie F. B. , Daly J. C. , Blamey R. W. 
Published: January 2008

Background: The omentum has been employed to cover the defect produced after resection of gross breast cancer recurrence for nearly three decades. Methods: A series of 11 patients undergoing omental transposition flap for very wide resection of gross local recurrence (LR) of breast cancer is reported. The median age was 39 years, with a short interval (median = 21 months) from the treatment of the primary tumour to LR. Local recurrence was gross and predominantly inflammatory. Results: All except one patient had lymphovascular invasion in the recurrent tumour. The omental graft was 100% viable but one patient required re‐application of further split‐thickness skin graft. The mean hospital stay was 16 days. Two cases of seroma formation were encountered. New recurrence developed around the periphery of the flap in eight patients after a median duration of local control of only 2.5 months. Eight patients died with metastatic disease after a median period of 6 months, six patients with uncontrolled local disease. Five patients were free from LR in over half of their remaining period of life. Conclusion: Omentoplasty is a safe and reliable procedure but the length of palliation achieved is often far from satisfactory.
FREQUENCY AND CLINICO‐PATHOLOGICAL ASSOCIATIONS OF RAS MUTATIONS IN COLORECTAL CANCER IN THE VICTORIAN POPULATION
Authors: Thomas Robert J. S. , Liu Yong‐Shu , St Clair Fiona , Norris Pamela M. , Valentine Renata , Phillips Wayne A. 
Published: January 2008

Background: Mutations in the oncogene ras occur in 20–50% of colorectal cancers. The presence of these mutations allows screening tests to be developed based on the identification of mutant DNA in cells derived from cancers. A study of the prevalence and clinicopathological associations of ras mutations was undertaken. Methods: The frequency of mutations in codons 12 and 13 of the K‐ras gene was investigated in 103 colorectal carcinomas using restriction fragment length polymorphism. Results: Mutations were detected in 32% (33/103) of the tumours, predominantly in codon 12 (25/33). No mutations were detected in normal‐appearing mucosa from the same patients. Conclusions: Analysis of the frequency of ras mutations compared with various independent clinical variables revealed a sex‐linked relationship between the presence of a ras mutation and nodal status but no correlation with any other clinical parameter was found. The findings suggest that screening tests based on ras mutation detection may lack sensitivity because of the presence of mutations in only 32% of tumours.
HYDROGEN SULPHIDE PRODUCES DIMINISHED FATTY ACID OXIDATION IN THE RAT COLON IN VIVO: IMPLICATIONS FOR ULCERATIVE COLITIS
Authors: Moore J. W. E. , Millard S. , Babidge W. , Rowland R. , Roediger W. E. W. 
Published: January 2008

Background: Several lines of evidence suggest a possible role for reduced forms of sulphur (including sulphide) in ulcerative colitis. The aims of this study were to assess the metabolic profile of colonic epithelial cells after treatment in vivo with hydrogen sulphide and correlate this with mucosal histological appearances. Methods: Adult Sprague‐Dawley rats had antegrade Roux‐en‐Y colostomies fashioned to allow access to the ‘in‐flow’ bowel. Animals were treated with 2 mL sodium hydrosulphide (10, 20, 30 mmol/L) or saline control twice daily via the stoma for four (acute experiments) and 90 (chronic experiments) days. Isolated colonic epithelial cell suspensions prepared from such animals were incubated in the presence of [l‐14C]‐labelled n‐butyrate (5 mmol/L) or [6–14C]glucose (5 mmol/L). Metabolic performance was measured radiometrically (14CO2 production) and enzymatically (ketone body production and lactogenesis). The histological appearances of treated mucosa were scored for acute inflammatory changes. Results: There was a highly significant reduction in 14CO2 production from both n‐butyrate and glucose in all groups compared to the control in both acute and chronic experiments. There was no difference between groups with respect to histological appearance and no evidence of acute inflammation in any specimen. Conclusions: Sodium hydrosulphide impairs rat colonic epithelial metabolic performance in vivo, but does not produce mucosal inflammation.
BREAST CANCER IN WESTERN AUSTRALIA IN 1989 V: OUTCOME AT 5 YEARS AFTER DIAGNOSIS
Authors: Stevenson Jayne M. , Bochenek Piotr , Jamrozik Konrad , Parsons Richard W. , Byrne Michael J. 
Published: January 2008

Background: A follow‐up study was undertaken of all Western Australian women who had a new diagnosis of breast cancer during 1989. The aims were to determine survival, frequency of recurrence and quality of life (QoL) of Western Australian women 5 years after a diagnosis of breast cancer; to determine reasons for choice or rejection of reconstructive surgery in those women treated by mastectomy, and to determine if the choice of lumpectomy or mastectomy affects subsequent QoL. Methods: The vital status as at 1st June 1994 of all 692 women who had a new diagnosis of breast cancer in 1989 was ascertained by electronic linkage to official mortality registrations. A subsample of 215 survivors who had originally been treated by the nine surgeons who had managed 20 or more cases each was sent a reply‐paid postal questionnaire asking about follow‐up treatment since diagnosis, recurrence of disease, current QoL and attitudes to, and use of, reconstructive surgery. Results: The overall survival rate at 5 years was 80.8% (85.9% and 78.8% for Stage I and II, respectively). Cumulative mortality was 35% lower among the third of patients treated by the nine most active surgeons (14%vs 22%, P < 0.02), but this may be subject to referral bias. The subsample was representative of all surviving cases except for being an average of 2.7 years younger at diagnosis (mean ages 55.2 and 57.9 years). The response rate of the subsample to the postal questionnaire was 78%. Of women who had had a mastectomy, 40% had considered having a reconstruction, but only nine (11%) had undergone this operation. Median QoL on the Rosser scale (maximum = 1.0) was 0.9. QoL was worse for the 23% of patients with a recurrence of breast cancer. Patients treated by breast‐conserving surgery showed a trend toward a better QoL compared with those treated by mastectomy. Conclusion: At 5 years after the diagnosis of breast cancer, one in five women had died and an estimated one in four of the survivors had recurrent disease. Quality of life in the remaining patients, half of whom had undergone adjuvant treatment, was very good. These are important baseline data against which to judge the impact of mammographic screening.