bluuebunny/crossref_metadata_2025_split huggingface dataset:
RECURRENT PERFORATION COMPLICATING INTESTINAL NEUROFIBROMATOSIS
Authors: Bhattacharyya Ratnakar , Jamieson Glyn G. 
Published: January 2008

A patient with diffuse intestinal neurofbromatosis who presented with recurrent small bowel perforation is described. Such recurrent perforation has not been reported previously.Management at first perforation consisted of laparotomy, and excision of the perforated nodular lesion, with removal of the gall‐bladder and appendix. The diagnosis of von Recktlinghausen's disease was confirmed by skin biopsy. Management of the second perforation was conservative, with administration of intravenous antibiotics, fluid replacement therapy, and nasogastric suction. The third perforation was treated surgically, with resection of the small bowel, leaving approximately 50 cm of small bowel. Such an approach represented a compromise between cure of the neurofibromatosis and leaving sufficient small bowel to allow satisfactory alimentation.
WEIGHT LOSS IN PATIENTS WITH HEAD AND NECK CANCER: MALNUTRITION OR TUMOUR EFFECT?
Authors: Shaw James H. F. , Humberstone David A. , Holdaway Christopher 
Published: January 2008

Isotopic infusions, hormone assays and calorimetry have been used to test the hypothesis that weight loss in head and neck cancer (HNC) patients is not due to pure malnutrition, but that a large component of the weight loss in these patients is a consequence of the metabolic effects induced by the tumour on the host.Twelve patients with advanced HNC were compared with eight depleted patients (DEP) who did not have cancer. Both groups had lost more than 10% of well body weight. Neither patient group had an elevated rate of energy expenditure as determined by calorimetry. Both glucose production and plasma glucose clearance were not significantly different between the two groups.The percentage of glucose production undergoing recycling to lactate was elevated in the HNC patients compared with the DEP patients. In addition, the percentage of glucose undergoing oxidation to CO2 was significantly lower in the HNC patients compared with the corresponding DEP value. The HNC patients were significantly more catabolic than the DEP patients and their serum cortisol concentration was also significantly elevated. Although the basal plasma insulin concentrations were similar in the two groups, the response to glucose infusion was markedly less in the HNC patients.It is concluded that patients with advanced HNC are metabolically different from starving patients, although both may lose a similar amount of weight. In particular, the adaptive response of protein conservation seen in simple starvation does not occur in the HNC patient.
PERIHEPATIC PACKING: ITS ROLE IN THE MANAGEMENT OF LIVER TRAUMA
Authors: Hollands M. J. , Little J. M. 
Published: January 2008

Perihepatic packing was used in 25 of 197 (12.7%) patients presenting with liver trauma to westmead hospital over an 8 year period. Packing was used either to provide temporary haemostasis prior to transfer or as part of a definitive treatment plan at this hospital. Thirteen patients were packed prior to transfer. Only two were unstable on arrival, one of whom died. They were compared with 18 ‘comparison’ patients with liver injuries of similar severity. In this group 10 were unstable on arrival (p= 0.027). Nine of whom died (p= 0.015). Packing was used as part of a definitive treatment plan at westmead on 17 occasions. Four patients were coagulopathic and five had also been packed prior to arrival. Eight of this group died.Packing is a convenient and safe way of controlling major hepatic haemorrhage prior to transfer to a tertiary referral centre. It may also be part of a definitive treatment plan to control hepatic bleeding especially as many patients arrive with a coagulopathy or develop a coagulopathy during the course of surgery to control bleeding. Packing will control haemorrhage until the coagulopathy has been corrected.
BILATERAL TESTICULAR AND ADRENAL MALIGNANT LYMPHOMA OF PRE B‐CELL TYPE
Authors: Coventry BrendonJ. , Nacey JohnN. , Orell Svante , Marshall VillisR. , Seshadri Ram 
Published: January 2008

A rare case of pre b‐lymphoblastic lymphoma of the testes and adrenal glands is presented. No lymph node, central nervous system or bone marrow involvement was demonstrated at diagnosis. The primary presentation was of acute unilateral pain and swelling, mimicking simple orchitis. The diagnosis was made using aspiration cytology and the lymphoma characterized using immunohistochemical, electron microscopic and karyotype analysis techniques.Pre b‐cell markers were clearly demonstrated by all criteria used. Monoclonal antibodies (fmc 29 and fmc 31) were used to define the early b‐cell nature of the lymphoma. Confirmation using karyotype analysis in addition to immunoglobulin and t‐cell β‐receptor gene rearrangement was obtained.Intrathecal chemotherapy was used prophylactically. Combination chemotherapy produced regression of the primary lymphomatous lesions, but subsequent bone marrow spread led to death.
DO BIG BREASTS DISADVANTAGE WOMEN WITH BREAST CANCER?
Authors: Ingram D. M. , Huang H‐Y. , Catchpole B. N. , Roberts A. 
Published: January 2008

The present study was undertaken in order to discover whether patients with breast cancer in large breasts experienced a delay in the detection of their cancer due to the bulk of the breast and consequently presented with more advanced tumours compared with women with small breasts.Mastectomy specimens were weighed and their dimensions measured, in particular recording breast mass and breast thickness (anterior‐posterior depth). Tumour diameter, the number of involved lymph nodes and the oestrogen and progesterone receptor levels were measured as prognostic indices.Although there was no difference in receptor status of tumours from large and small breasts, on presentation, patients with big breasts had larger tumours and more involved lymph nodes than women with small breasts, whether breast size was assessed by weight or thickness. Women with large breasts may therefore be expected to fare worse than those with small breasts.
A HEPARIN TEST AS A PREDICTOR OF POSTOPERATIVE DEEP VEIN THROMBOSIS
Authors: Randle P. M. , Catchpole B. N. , Ingram D. M. , Kennett D. W. G. 
Published: January 2008

A heparin test was developed and tested (o determine if it could predict which patients were likely to develop postoperative deep vein thrombosis (dvt). The test was based on the observation that approximately one‐third of normal subjects have a reduced anticoagulation response to heparin.Fifty‐four adult patients undergoing abdominal operations, and who were not receiving dvt prophylaxis, were pre‐operatively given 20u heparin/kg intravenously and the thrombin clotting lime was determined 30min later (tct 30). Forty‐two had a normal response of a tct 30 > 120s, the remainder having a positive test of tct 30 < 120s. The heparin test accurately predicted four of the seven patients who developed postoperative dvt as determined by the 125i‐fibrinogen test, and correctly identified 39 of the 47 who did not develop dvt (p > 0.05). No patient developed clinical dvt.This simple test could be of practical value in clinical surgery in predicting which patients are at risk of postoperative dvt and require prophylaxis.
PAEDIATRIC BICYCLE INJURIES
Authors: Cass D. T. , Gray A. J. 
Published: January 2008

Bicycle injuries are an important cause of trauma. Approximately 75% of such accidents occur in children and involve difficult decisions in the areas of education, engineering and legislation. A prospective 3‐year study was undertaken to understand the range of injuries and in particular to concentrate on severe injuries.In all. 251 children were admitted to westmead hospital after receiving bicycle injuries. Most injuries were minor but there were 37 serious injuries and six deaths. Head injuries predominated, especially in the seriously injured. The rate of wearing helmets was low, with less than 10% of all admissions wearing a helmet. None of the seriously or fatally injured wore a helmet. Helmet‐wearing remains the single most important preventative measure to be instituted if the serious morbidity and mortality rates associated with bicycle injuries are to decrease.
REPORT OF FOUR CASES OF ANEURYSM COMPLICATING PATCH AORTOPLASTY FOR REPAIR OF COARCTATION OF THE AORTA
Authors: John ColinN. , Cartmill TimothyB. , Johnson DavidC. , Nunn GrahamR. 
Published: January 2008

Patch aortoplastry, used almost routinely in the period 1972–86, except in infants in the operative treatment of coarctation of aorta, is sometimes complicated by late formation of true or false aneurysms. This complication, which seems likely to increase with longer follow‐up, calls into question the advisability of patch aortoplasty except when it has specific advantages. Other surgical techniques such as subclavian flap angioplasty in infants and young children or radical excision with end‐to‐end anastomosis may be preferable where there is no anatomical contraindication.In any case, lifelong yearly review of postoperative patients should include chest x‐ray and further investigation by computerized tomography scanning or other suitable imaging of those with suspicious findings.
HYPOXIA AND HYPOTENSION DURING ENDOSCOPY AND COLONOSCOPY
Authors: Lancaster J. F. , Gotley D. , Bartolo D. C. , Leaper D. J. 
Published: January 2008

Sixty‐three patients undergoing oeasophagogastrodudenoscopy (OGD) (n=24)or proctosigmidocolonoscopy (PSC) (n= 39) had continuous monitoring of arterial oxygen saturation (SaO2), pulse and mean blood pressure (BP). The degree of patient distress, duration, dose of aedalive and details of the endoscope and operator were recorded.Marked hypotensive (> 40% fall in BP) and hypoxic (> 8% fall in SaO2) or changes occurred in 13% and 17% of the overall group, respectively. There were no significant differences in fall in BP, Sao2 or pulse between the OGD and PSC groups. The dose of sedative was significantly related to the fall in SaO2 (P < 0.001) but not to the fall in BP. The falls in both SaO2 and BP were related to the duration of the procedure (P < 0.001, P= 0.03, respectively). There were no correlations between the degree of hypoxia or hypotension and the patient's age or previous medical history. Hypotension and hypoxia occur in both colonoscopy and OGD and are neither predictable nor usually recognizable clinically. Pulse oxinietric and BP monitoring throughout gastrointestinal endoscopy are recommended for maximal safety.
BREAST CANCER CYTOGENETICS AND BEYOND
Authors: Hainsworth P. J. , Garson O. M. 
Published: January 2008

It is hypothesized that cancers arise as a result of genetic or chromosomal alteration. Evidence for this provided by the leukaemias and lymphomas in which cytogenetic studies are of established value in diagnosis, classification and follow‐up. In contrast, the cytogenetic study of all solid turnours, including breast carcinoma, is in its infancy.However, cytogenetic studies indicate that clonal structural alterations do occur, affecting several loci on a number of chromosomes. Molecular studies provide further evidence of recurring chromosomal breakpoints breast cancer. This paper reviews the chromosomal rearrangements observed to date and discusses their relevance to the biology of breast cancer.
EARLY EXPERIENCE WITH NEEDLE LOCALIZATION AND BIOPSY OF MAMMOGRAPHIC LESIONS
Authors: Bird D. , Hart S. 
Published: January 2008

Increasing awareness of the value of mammography by both physicians and the public has resulted in women presenting more commonly with impalpable breast lesions. This study reviews the radiology and pathology of 58 such lesions biopsied by the Monash Medical Centre Breast Unit between August 1987 and October 1988. Abnormal mammograms were reported by one of two independent radiologists in the normal course of practice and placed into one of five categories according to the radiological appearance. Those lesions scoring ≥ 3 were then needle localized, excised and examined histologically. All mammograms were later reported as unknowns by the other radiologist and similarly scored. Sixteen (28%) of these lesions were invasive or in situ carcinoma and of these a significant number were scored differently by the two radiologist.The results indicate that needle localization biopsy of suspicious mammographic lesions is a safe, accurate method for the diagnosis of ealry breast cancer. The results also show significant variation between radiologists and demonstrate the need for double reading of screening mammographic films. It is suggested that doubtful lesions require more extensive work‐up with compression/magnification and other special view, the aim being more accurate radiological assessment and a reduction in the benign biopsy rate.
BLOOD ORDERING FOR HAEMATEMESIS
Authors: Kohn Michael R. , Rowlings Philip A. , Ham John M. 
Published: January 2008

The blood ordering practices for acute upper gastrointestinal bleeding were assessed in 162 consecutive patients presenting with haematemesis admitted via the Accident and Emergency Centre. The patients were classified according to their estimated blood loss and haemoglobin level at the time of admission, and the amounts of blood ordered and given in the next 24 h were determined.The crossmatch: transfusion (CT) ratio was very high in one group (14.9), although the overall ratio of 2.4 was acceptable. There were variations in the ordering pattern of different medical officers, possibly because of the absence of clear guidelines.From the data obtained, a set of guidelines for ordering blood in this clinical conditions was developed. It was estimated that if these guidelines had been used, there would have been a reduction of one‐third of all units crossmatched, and that the overall CT ratio would have been reduced to 1.6.
SURGICAL KNOWLEDGE BASE AUGMENTATION BY MEDICAL ROTATIONS: DOES IT HAPPEN?
Authors: Miller Brian J. , Effeney David J. , Isaacs Geoff 
Published: January 2008

A study of 4 groups of fifth year medical students taking Surgery during the 4 terms of 1989 at the University of Queensland was undertaken to determine whether there was assimilation of factual material relevant to the surgical knowledge base from the other specialty rotations done during the same year of the course. The records of multiple choice question (MCQ) examination results for the 210 students were retrieved and reviewed. The performances of the same students during their fourth‐year rotation in Surgery was checked to make sure that 4 groups did not already display unusual surgical aptitude or incompetence. The questions were categorised in order to ascertain that the content of all the examinations was similar.The results of students doing surgery during te first of the 4 terms in 1989 were compared with subsequent groups. The difference between the groups was that those in the first term had not had the benefit of fifth year rotations through Internal medicine, Psychiatry, General Practice and electives. Subsequent groups had increasing experience in the other specialities. The fourth and final group in the year had undertaken all four of the other rotations before doing Surgery.Significant improvement was found in the performances of each of the subsequent groups of students compared with the first‐term group. This implies that there is an escalating accrual of factual knowledge related to surgery from the fifth‐year curses in Internal medicine, Child Health and Psychiatry.
PRE‐AND POST‐TESTING OF STUDENTS IN SURGERY: DO MEDICAL ROTATIONS HELP?
Authors: Miller Brian J. , Effeney David J. , Chan Steven T. 
Published: January 2008

A prospective multiple choice question (MCQ) study developed to pre‐ and post‐test fifth year medical students at the University of Queensland. was undertaken during 1990. We investigated whether there was a significant gain in their surgical knowledge base resulting from non‐surgical rotations during the same year. We have previously reported a retrospective study suggesting that there was such a gain. Comparable clinical surgical pre‐ and post‐tests were adapted from a fresh question bank, and were presented prospectively to four groups of fifth year medical students at the beginning and end of each 7 week General Surgical term. In contrast to our retrospective study, we found there was no significant increment in surgical knowledge using non‐parametric Notched Box and Whisker Plot analysis of data.We conclude that this is either because students are compartmentalizing their factual knowledge base between one speciality and the next, or that indeed there is no benefit to Surgical knowledge base from prior non‐surgical rotations. Assuming the former, a combined Medical and Surgical Objective Structured Clinical Examination (OSCE) at the end of the fourth year could serve to broaden the student's horizons and reduce factual dissociation during the fifth year.
'MRS L.‘S CASE’: A CELEBRATED SOUTH AUSTRALIAN SURGICAL CASE
Authors: Elmslie R. G. 
Published: January 2008

This paper concerns a dispute at the adelaide hospital in september 1896 between professor archibald watson, pathologist, honorary consulting surgeon and sole remaining university teacher at the hospital, and alexander disney leith napier. Who had arrived from england to fill the place of the honorary surgeons who had resigned from the hospital. Watson accused napier of incompetence in his management of ‘mrs l.’, who died after a femoral hernia operation. Mrs l had a form of internal hernia causing intestinal obstruction, whereas all the medical attendants, including watson, originally thought an old femoral hernia was the cause of her illness. By fortuitous coincidence the operation on the femoral hernia could have cured the internal hernia if the band of omentum attached to the femoral hernia had been divided. Watson became aware of the band at the post‐mortem and then asserted that the operation should have taken it into account. Napier complained to the board of the hospital, alleging that watson had misrepresented the facts when he conducted the post‐mortem on the patient and that he was disloyal to the hospital. The board found the complaint proved and invited watson to resign; he declined and was dismissed. Undaunted, watson circulated a privately printed pamphlet (entitled ‘mrs l.'s case’), which re‐stated the events of the case and graphically described his post‐mortem findings.It was submitted to the chairman of a select committee of the legislative council of south australia established to review the running of the hospital. The committee recommended the setting up of a royal commission but the government let the matter lapse. The opportunity for continued clinical teaching of students at the adelaide hospital, already poor when this dispute started, was lost. Only the balm of time and the spirit of compromise healed the rift and allowed clinical teaching to begin again in 1900. The lessons in this cautionary tale are considered.
PERCUTANEOUS LAPAROSCOPIC CHOLECYSTECTOMY: THE FIRST FIFTY
Authors: Nottle P. D. , Wale R. J. , Johnson W. R. 
Published: January 2008

A series of 50 percutaneous laparoscopic cholecystectomies was performed by one surgeon between 7 June and 25 October 1990 using a modified technique as described by Dubois.There were 42 females and 8 males, the average age being 44 years with a range of 14–76 years. The average operating time was 80 min. ranging from 35 to 210 min.Postoperative stay averaged 2.9 days and there was an average of 11 days to return to work.Complications consisted of a subhepatic bile collection requiring open drainage, one minor wound infection and one minor abdominal wall haematoma.Laparoscopic cholecystectomy is a safe technique for removing the gall‐bladder resulting in a rapid convalescence and early return to work. The initial learning curve is long and careful case selection should be carried out in this phase.
SURGICAL TREATMENT OF BILIARY STRICTURE WITH PORTAL HYPERTENSION USING VENO‐VENOUS BYPASS
Authors: Christophi C. , Dudley F. , McInnes I. E. 
Published: January 2008

The surgical treatment of benign bile duct stricture with portal hypertension may be hazardous and, in some cases, involve a 2‐stage procedure. An initial porta‐systemic shunt is performed followed by surgical correction of the stricture at a second operation.The use of veno‐venous bypass, as described, provides a temporary porta‐systemic shunt, allowing a I ‐stage repair of the stricture to be carried out.
COMPETENCY AND THE COLONOSCOPIST A LEARNING CURVE
Authors: Parry Bryan R. , Williams Sheila M. 
Published: January 2008

The first 334 consecutive unassisted studies of a trainee colonoscopist were audited to analyse the relationship between experience and a target 90% completion rate of colonoscopy. The cumulative sum (cusum) score was applied to examine the time trend for the attaining of the target 90% completion rate. This technique described a learning curve which showed, in this instance, that approximately 100 studies were necessary before a 90% completion rate was approached. A further 100 studies were required before this target completion rate was achieved consistently. A trend for continued improvement above the 90% completion rate level was also seen after 200 studies. Polypectomy was completed in 117 of the 123 studies where indicated.Cusum analysis may be a useful method for monitoring the progress of the trainee colonoscopist and the attainment of satisfactory competence. Training requirements, therefore, might better emphasize the attainment of an acceptable completion rate rather than an arbitrary quota per se.
PNEUMATOSIS CYSTOIDESINTESTINALIS: AN EXPERIENCE WITH HYPERBARIC OXYGEN TREATMENT*
Authors: Grieve D. A. , Unsworth I. P. 
Published: January 2008

Gut wall gas cysts are uncommon and are an occasional cause of abdominal symptoms. Their aetiology is uncertain and both bacterial infection and chronic airways disease are popularly held theories.At Prince Henry Hospital (PHH) between 1980 and 1986. 8 patients with pneumatosis cystoides intestinalis (PCI) underwent 11 courses of hyperbaric oxygen treatment (HBO).This is the largest reported series of HBO treatment of PCI. In April 1990 attempts were made to recall all patients to assess cyst and symptom status. Two had died from unrelated causes; the other six were reviewed—of these, one declined further endoscopy and the other five consented.The 11 courses of treatment all resulted in pronounced symptomatic responses. This was followed by 7 early symptomatic recurrences and 4 long‐term cures. These four remain asymptomatic and cyst‐free at a minimum of 4 years to a maximum of 9 years follow‐up. Of these 4 cures, cyst resolution was documented immediately post‐HBO treatment in two and not assessed in two. In the 7 recurrences, failure of cyst resolution was documented immediately post‐HBO treatment in six and not assessed in one. Three patients had chronic airways disease, and two of these have complete resolution of PCI.It is concluded that HBO treatment is effective for PCI provided it is continued until cyst resolution has occurred and not just until symptomatic improvement. These observations suggest that KI is curable and argues against the pulmonary theory of aetiology.
MEDIAL UNICOMPARTMENT KNEE REPLACEMENT. MINIMUM FIVE YEAR FOLLOW‐UP
Authors: Dalen J. van , Krause B. L. 
Published: January 2008

Forty‐four medial Marmor unicompartment knee arthroplasties were performed at the Hutt Hospital from 1976 to 1983 on 35 patients. Seventy‐five per cent were rated as excellent or good, using the Hospital for Special Surgery Knee Rating System. Four arthroplasties were revised at an average of 6 years (range: 2–8). two for late degenerative change in the lateral Compartment, one for malposition and one for loosening. There was one late deep infection requiring an arthrodesis at 2 years.It is concluded that medial compartment knee arthroplasty provides satisfactory treatment in the elderly patient, although attention must be directed to technical aspects and patient selection, to afford long‐term success.