bluuebunny/crossref_metadata_2025_split huggingface dataset:
MID‐COLON OESOPHAGOCOLOPLASTY FOR CORROSIVE OESOPHAGEAL STRICTURES
Authors: Ananthakrishnan N. , Rao K.S.V.K. Subba , Radjendirin P. 
Published: January 2008

Corrosive strictures of the oesophagus are common and being long and dense frequently require surgical replacement of the oesophagus. Presently available techniques of oesophagocoloplasty are associated with a significant mortality and major morbidity, such as a high rate of ischaemic necrosis of the colon, cervical salivary fistula or oesophagocolic stenosis.A method of mid‐colon oesophagocoloplasty using an isoperistaltic colonic segment from the mid‐ascending to the mid‐descending colon is reported. The procedure was carried out in 33 patients. The conduit was placed retrosternally in 27 patients and subcutaneously in the rest. The essential steps of the procedure are simultaneous neck and abdominal dissection, near‐total mobilization of the colon from the ileocaecal segment to the sigmoid colon and sequential clamping of ileocolic, right colic and usually the middle colic vessels leaving the left colic vessels as the major vascular pedicle. The divided ileum is used to pull the colon into position thus avoiding traumatization of the colon and leaving the whole length of the mobilized colon available for anastomosis. A wide side to side oesophagocolic anastomosis in the neck, resection and discarding of the bulky terminal ileocaecal segment after completion of the cervical anastomosis, closure of the terminal end of the colon and its placement adjacent to the hypopharynx and end to side cologastric anastomosis complete the procedure. There was no mortality and there was no instance of colonic necrosis. The procedure restored an ability to eat normal food in 93.9% of patients compared to only 39.2% of patients with bougienage.The major advantages of this procedure are a uniformly adequate length of colon, excellent vascularity, avoidance of a potentially ischaemic colonic end in the oesophagocolic anastomosis, with its attendant sequelae such as cervical fistulae or oesophagocolic stenosis, low incidence of complications and the possibility of easy correction of oesophagocolic stenosis should it occur after the procedure. Cervical fistulae occurred in 10 patients and spontaneously closed in nine. Cervical anastomotic stenosis occurred in only one instance. The functional results and complication rate reported here are superior to most other series of oesophagocoloplasty for corrosive strictures reported in the literature. The operation is technically easy and is a significant improvement on existing methods of oesophageal replacement.
LAPAROSCOPIC CHOLECYSTECTOMY AND MANAGEMENT OF CHOLEDOCHOLITHIASIS
Authors: Wilson T. G. , Jeans P. L. , Anthony A. , Cox M. R. , Toouli J. 
Published: January 2008

The advent of laparoscopic cholecystectomy (LC) has led to a reassessment of the approach to the management of choledocholithiasis. In a consecutive series of 418 patients undergoing LC, common bile duct (CBD) stones were suspected pre‐operatively in 130 patients. Forty‐five of the patients (35%) were found to have CBD stones on either pre‐operative endoscopic retrograde cholangiopancreatography (ERCP; 20) or on operative cholangiography (OC; 25). Common bile duct stones were detected on OC in a further 12 of 288 patients (4.2%) without pre‐operative suspicion of choledocholithiasis. Of the total of 57 patients with CBD stones, the duct was cleared by pre‐operative ERCP and endoscopic sphincter‐otomy (ES) in 15 patients. In 13 patients, two of whom had had a pre‐operative ERCP and ES, duct clearance was achieved by relaxing the sphincter pharmacologically and flushing the CBD via the OC catheter. One patient had an on‐table ERCP and ES with successful stone extraction during LC. Eleven patients were converted to open operation with bile duct exploration. Sixteen patients had a postoperative ERCP. In five patients the CBD stones had passed spontaneously in the time between LC and ERCP. Ten patients required ES to clear the duct of stones. One patient had a failed ERCP and is still awaiting a repeat. The remaining patient was scheduled, but did not return for follow‐up ERCP.In summary, pre‐operative ERCP was indicated in less than 10% of patients in this series. It was possible to deal with over one‐third of CBD stones found at LC by the simple technique of pharmacological relaxation of the spincter of Oddi and flushing the duct through the cholangiogram catheter. Of the patients who required follow‐up ERCP, one third had passed their CBD stones by the time of the examination and the rest required ES for stone extraction. Less than 3% of the entire series of patients were converted to open operation for exploration of the common bile duct.
SURGICAL MANAGEMENT OF ARTHRITIS OF THE CARPO‐METACARPAL JOINT OF THE THUMB
Authors: Conolly W. Bruce , Lanzetta Marco 
Published: January 2008

In the years 1970–90, 118 procedures were performed on 100 patients with arthritis (osteoarthritis in all but 13) of the carpo‐metacarpal joint of the thumb. The patients were aged 17 to 83 years (mean 54.5 years); 75 were females and 25 males; there were 73 right and 45 left hands; 18 patients had bilateral procedures. The average follow up period was 4.3 years, with a range of 1 to 20 years. Sixteen of the 118 procedures were arthrodeses; all these patients had isolated trapezio‐metacarpal joint arthritis. Fifteen procedures were trapeziectomies and soft tissue arthroplasties; they were performed for pan‐trapezial arthritis in the older age group, or as a secondary procedure for failed previous operations. Eighty‐seven of the 118 procedures were silicone partial or total arthroplasties either for pan‐trapezial arthritis or isolated trapezio‐metacarpal joint arthritis (53 trapezium, 32 metatarso‐phalangeal and 2 condyle implants).The overall results were: arthrodesis (68.7% good, 18.8% fair, 12.5% poor); soft tissue arthroplasty (80% good, 6.7% fair, 13.3% poor); silicone total arthroplasty (73.5% good, 15.1% fair, 11.3% poor); silicone hemiarthroplasty (68.8% good, 15.6% fair, 15.6% poor). No silicone synovitis was found in any of the 87 cases of silicone arthroplasties.
THE VALUE OF FROZEN SECTION EXAMINATION IN PLANNING SURGERY FOR FOLLICULAR THYROID NEOPLASMS
Authors: Neale M. L. , Delbridge L. , Reeve T S. , Poole A. G. 
Published: January 2008

Frozen section examination of follicular neoplasms of the thyroid has been claimed to be of little value in planning the extent of surgery. Clinical factors such as age, sex and tumour size are said to be more accurate predictors of malignancy. The aim of this study was to examine the respective value of clinical factors and frozen section in the surgical management of follicular thyroid neoplasms. A retrospective study of 735 patients with follicular neoplasms treated at Royal North Shore Hospital was undertaken. Factors assessed included clinical features, such as age and sex of the patients and tumour size, as well as findings at frozen section examination. No significant difference in sex distribution was demonstrated when comparing follicular adenoma with follicular carcinoma. There was a significant difference with respect to patient age between the two groups, but the large overlap in the distribution made this difference of no clinical value. In addition, there was no significant difference in tumour size when comparing follicular adenoma with carcinoma.On the other hand, review of frozen section results showed that 40% of patients with follicular carcinoma were positively identified by frozen section examination at initial surgery, with a false positive rate of less than 0.2%. It appears that clinical factors, such as age, sex and tumour size, are of little assistance in differentiating benign from malignant follicular neoplasms. Frozen section examination remains the most definitive tool in planning intra‐operatively the extent of surgery for follicular neoplasms of the thyroid.
CARCINOMA OF THE THYROGLOSSAL DUCT CASE REPORTS AND A LITERATURE REVIEW
Authors: Chen Frank , Sheridan Brian , Nankervis Jane 
Published: January 2008

Carcinoma of the thyroglossal tract is a rare entity. Three patients with thyroglossal cyst carcinomas are presented and the features of the disease, as reported in the literature, are discussed. Epidemiologically, females are more often affected than males and the average age of the patients described lies in the fourth decade. The aetiology is obscure, although previous irradiation is a possible risk factor, Carcinoma of the thyroglossal tract should also be suspected in patients with irregular masses.Pre‐operative evaluation may include a thyroid scan and fine needle aspiration cytological examination of the cyst fluid. These tests, if positive, may alter the basic approach of the Sistrunk procedure to encompass thyroidectomy or wider margins. Neck dissection is preferred for cervical nodal disease. Adjuvant radiotherapy or radio‐iodine is added if indicated by the histology, and the patient receives suppressive thyroxine therapy thereafter.
A COMPARISON BEWEEN RADIOLIGAND AND IMMUNOHISTOCHEMICAL ASSAY OF HORMONE RECEPTORS IN PRIMARY BREAST CANCER
Authors: Charalambous D. , Kitchen P. R. B. , Stillwell R. G. , Smart P. J. , Rode J. 
Published: January 2008

The detection of oestrogen and progesterone receptor (ER and PgR) levels in human breast carcinoma has traditionally been performed using a biochemical radioligand binding method. This method hasseveral disadvantages including the requirement for generous tissue samples, the production of radioac‐ tive waste products and the inability to exclude non‐malignant cellular material from the assay process. An alternative method for detecting hormone receptors is available with the use of a monoclonal antibody specific for the ER or PgR receptor using immunocytochemical assay (ER‐ICA or PgR‐ICA). Although designed for use on frozen section material, with modifications this method can be used onparaffin sections of routinely fixed and processed tissue, on archival material and on very small specimens. Further, an objective assessment or scoring of staining intensity is possible using computerized video‐image analysis.Forty‐three cases of primary breast carcinoma, treated from 1989 to 1991 at Goulburn Valley Base Hospital, Shepparton were assessed for ER and PgR content using both the radioligand method andimmunohistochemistry with video‐image analysis, and the results were compared. Of the 43 cases, ER‐ ICA and ER had a concordance of 81% (P < 0.001, r = 0.58) and in 39 cases, PgR and PgR‐ICA had aconcordance of 87% (P < 0.001, r = 0.54). Because the sample for radioligand assay is of uncertain composition and the immunohistochemical stain can be scored specifically for malignant epithelium, adegree of discordance is thought to be mostly attributable to the limitations of the radioligand assay.
MANAGEMENT OF UNREPAIRABLE URINARY VAGINAL FISTULAE IN A DEVELOPING COUNTRY
Authors: Attah Charles A. , Ozumba Benjamin C. 
Published: January 2008

Thirty‐eight out of 44 patients with unrepairable urinary and rectal vaginal fistulae obtained good to excellent results from diverting the urine by uretero‐colic anastomosis. The patients who hitherto were regarded as social outcasts became integrated into society once again.Intestinal conduits are generally not employed for urinary diversion, because of the social dislike for colostomies and ileostomies, coupled with the lack of availability of the necessary external appliances, in Nigeria. In spite of the good results recorded, it is felt that urinary diversion by uretero‐colic anastomosis for vesico‐vaginal fistulae should be regarded as the last resort; there are well‐known adverse complications from the operation, coupled with psychological trauma to the patients because of their inability to micturate in the normal fashion.
VALUE OF THE PROSPECTIVE ‘BEFORE AND AFTER’ STUDY AS A METHODOLOGY TO EVALUATE OUTCOME IN A TRAUMA CENTRE
Authors: Hill David A. , West Richard H. , Duflou Johan 
Published: January 2008

A series of interventions (administrative, clinical and educational) was introduced to improve the quality of trauma care at Royal Prince Alfred Hospital, the designated trauma centre for the Central Sydney Area Health Service (CSAHS). A prospective, ‘before and after’ study was conducted to assess changes in outcome following the introduction of these measures.The trauma centre survival rate for patients admitted with serious injury (Injury Severity Scores > 15) increased significantly, from 72% in the nine months before trauma centre designation to 89% in the nine months after (P= 0.005). The peer review designated, potentially avoidable death rate did not change significantly over the two study periods, remaining in the 20–30% range. Similarly the unexpected death rate (TRISS) did not change significantly, remaining in the 20–45% range. A trend to a lower trauma centre mortality in those arriving with a systolic blood pressure 90 mmHg was noted. Seven out of 14 patients ‘at risk’ from exsanguination died in the first 9 months compared with one out of seven in the second 9 months (P = 0.17).An unexpected finding was a change in the degree of injury severity and physiological status in patients arriving at the trauma centre. The Injury Severity Scores were significantly lower (P= 0.008) and the Revised Trauma Scores significantly higher (P= 0.0006) in the latter 9 months of the study. It was concluded that the improved trauma centre survival rate was a reflection of a reduced hospital mortality from haemorrhagic shock in conjunction with a lesser degree of injury severity in patients admitted from the CSAHS.
ASPECT IN THE PACIFIC: WALKING THE AID TIGHTROPE
Authors: Galbraith J. E. K. 
Published: January 2008

The Australian South Pacific Eye Consultant Teams (ASPECT) have been functioning since 1985, building on previous experience with the provision of eye health services in the independent countries of the South Pacific.The key issues in the provision of aid to developing countries are the desires of those countries to receive aid, the delivery of care that is pertinent to local conditions and the training which can be delivered to local health care workers so that aid programmes will eventually make themselves redundant.
CHANGES IN THE PRACTICE OF BILIARY SURGERY AND ERCP DURING THE INTRODUCTION OF LAPAROSCOPIC CHOLECYSTECTOMY TO AUSTRALIA: THEIR POSSIBLE SIGNIFICANCE
Authors: Fletcher David R. 
Published: January 2008

Two and a half years after the introduction of laparoscopic cholecystectomy to Australia in February 1990, estimates from Medicare statistics suggest that by July 1992, 69% of cholecystectomies were being performed laparoscopically. There was a smaller decline in the numbers of open cholecystectomies performed. suggesting a 28% rise in the rate of cholecystectomy. This has been associated with a 66% decline in the use of intra‐operative cholangiography. Whereas 87% of cholecystectomies had an operative cholangiogram performed, now only 23% of all cholecystectomies do. It is suggested that in approximately half the patients, no attempt is made to exclude common duct stones. With those patients in whom an attempt is made, most surgeons rely on endoscopic retrograde cholangiopancreatography, as evidenced by a 43% increase in its use, or, more recently, a small proportion of surgeons have been using intravenous cholangiography, as evidenced by a 26% increase in its use. Once diagnosed, these stones are no longer being treated by open exploration of the bile duct, indicated by a 46% decrease in this procedure, but are being treated by endoscopic sphincterotomy, which has shown a 242% increase in its use.From the published results of the outcome of these treatments, the added risk, nationally, of these additional procedures in managing uncomplicated bile duct stones is predicted to increase mortality 1–3‐fold and morbidity 10–15‐fold. This risk can be reduced by the use of laparoscopic bile duct exploration. These techniques are already well established and can be learnt quickly if practice is achieved by performing routine intra‐operative cholangiography. The treatment of common duct calculi at the time of cholecystectomy still seems to be the most efficient strategy of management, even in the laparoscopic era.
A SELECTIVE APPROACH TO NECK DISSECTION FOR MUCOSAL SQUAMOUS CELL CARCINOMA
Authors: J. O'Brien Christopher 
Published: January 2008

A personal series of 189 neck dissections performed over 6 years among 154 patients with mucosal squamous cell carcinoma is presented. The most common primary sites were the oral cavity (66). oropharynx (38) and hypopharynx (17). There were 104 therapeutic and 85 elective neck dissections. Over 40% of therapeutic dissections were modified or selective procedures. Radical neck dissection was never used electively.Seventy‐eight patients (50%) had postoperative radiotherapy to the neck. Nodes were histologically positive in 110 dissections overall (58%); 92% of therapeutic dissections and 17% of elective dissections. Extracapsular spread was present in 65% of positive dissections. Ipsilateral neck recurrence developed in 10 of 60 patients who had therapeutic radical dissections (17%) and in 2 of 44 patients who had therapeutic, modified or selective dissections (5%). Recurrence after elective dissection occurred in only one patient (1.2%). It is concluded that modified and selective neck dissection are safe and oncologically effective when used among selected patients and combined with adjuvant radiotherapy. Neck recurrence may still occur among patients with advanced and biologically aggressive disease despite radical therapy.
TRAUMATIC THORACIC AORTIC RUPTURE: INVESTIGATION DETERMINES OUTCOME
Authors: Hills Michael W. , Thomas Scott G. , McDougall Patricia A. , Hewitt‐Falls Elizabeth A. , Graham John C. , Deane Stephen A. 
Published: January 2008

Blunt thoracic aortic rupture (TAR) initially presents with subtle signs but is usually fatal if not diagnosed and treated early. Does the diagnostic process affect outcome? The definitive test most widely promoted is thoracic (arch) aortography but is usually only available in major teaching hospitals. Thoracic computerized tomography (CT) scanning is more readily available but its role in diagnosis of TAR is unproven.A retrospective review of trauma databases and medical record indexes over a 7 year period identified 38 patients presenting with TAR at Westmead and Royal North Shore Hospitals in the period 1984–91.Thirteen patients (34%) were dead on arrival or died within 15 min of arrival at either hospital. Five patients (13%) who arrived in cardiac arrest (with suspected TAR) died after immediate thoracotomy (two in the Emergency Department and three in the operating room). Two patients (5%) died from severe head injuries and were not investigated for TAR.Eighteen patients (47%) remained alive long enough for investigation and were considered potentially salvageable. Nine of these survived. Only 13 patients had arch aortography. No patient survived without an aortogram. Five patients had a chest CT scan; aortography followed in four patients. Computerized tomography scans delayed aortography or were misinterpreted. Review of all trauma thoracic (arch) aortograms for the same period at Westmead Hospital revealed a diagnosis of TAR in 7.4%.Blind thoracotomy did not result in survival. Computerized tomography scanning of the chest was of no value in the management of this injury. Early suspicion of possible thoracic aortic rupture demands urgent arch aortography and this remains the diagnostic ‘gold standard’.
A METHOD OF PRE‐OPERATIVE ASSESSMENT FOR POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Clayer M. , Atkinson R. 
Published: January 2008

The use of the bone‐patellar tendon‐bone graft has been well established in anterior cruciate ligament (ACL) reconstruction. The value of this graft in posterior cruciate ligament (PCL) reconstruction has not been documented. A template was used to identify the origin and insertion of the PCL on standard lateral radiographs of the knee. Those patients who were found at arthroscopy to have an intact articular surface were measured using the template.Thirty‐nine patients (40 knees) were included for study, the difference between the PCL and patellar tendon length was expressed as a percentage. The mean was 125% (range 98–165%). To assess the reproducibility of the technique, in 17 patients a repeat radiograph was taken and the two measurements compared. These were found to have a significant correlation (R, coefficient 0.79, P < 0.001).The use of autologous bone‐patellar tendon‐bone graft obviates the need for allograft with its incumbent problems. This method of measurement indicates that the patellar tendon graft would be long enough to be suitable for PCL reconstruction in the majority of cases.
MASTALGIA: A 3 YEAR AUSTRALIAN STUDY
Authors: Wetzig Neil R. 
Published: January 2008

Mastalgia is a common but often poorly understood condition with little Australian data available on the subject. Details are presented of 170 patients who have attended a specific mastalgia clinic at the Princess Alexandra Hospital, Brisbane, Queensland, over a 3 year period. The aims and management protocol of the clinic are outlined.The mastalgia sufferer in this study had an average age of 42 years and 87% were multiparous. Cyclical pain occurred in 59% as determined by a daily pain record chart. Unilateral pain occurred in 38%. Lack of previous breast feeding and low levels of regular physical exercise were identified as two significant factors in the history of those attending the clinic. The responses to treatments are outlined. Response rates of 18 and 26% to two commonly used ‘natural products’, Vitamin B6 and Evening Primrose Oil, respectively, are considered little better than placebo effect. A complete response was achieved in 67% of women who took low dose danazol with minimal side effects. The overall response rate to all treatments was 65% with a mean follow up of 15.5 months for those women who continued to attend the clinic. For women with mastalgia, a systematic approach can achieve relief of pain.
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) AND STENT PLACEMENT IN THE MANAGEMENT OF LARGE COMMON BILE DUCT STONES
Authors: Navicharern P. , Rhodes M. , Floor D. , Lawrie B. 
Published: January 2008

Management of large common bile duct (CBD) calculi is controversial. Endoscopic treatment is fraught with difficulty, particularly when stones are over one centimetre in diameter and the patient's coagulation is deranged. Between 1988 and 1993, 56 patients have been managed by endoscopic retrograde cholangiopancreatography (ERCP) and stent placement as the initial treatment for large CBD calculi. Complete follow up has been possible in 50 cases (89.3%). The median age was 73.5 years (range 29–92) and primary presenting symptoms were jaundice (n= 39), cholangitis (n= 6) or abdominal pain (n= 5). Median bilirubin was 99 μmol/L (range 7–926) and 60% of the patients had deranged clotting with a median thrombotest of 61%. Stones ranged in size from 0.9 to 4.5 cm (median 1.6 cm). Treatment was with a 7F 'pigtail' stent in 39 cases and a 10F straight stent in 11 patients. Morbidity occurred in 12% of cases with two deaths (4%).Stents remained in place for a median of 1 month (range 0.2–59). Definitive treatment of CBD stones, once the jaundice and sepsis had settled, involved surgery in 24 patients and repeat ERCP with sphincterotomy +/‐ mechanical lithotripsy in 17 cases. Nine patients remain alive and well with their stents still in place. Initial management of large CBD calculi by ERCP and stent placement carries a low morbidity and mortality and is a useful adjunct in the management of a difficult clinical problem.