bluuebunny/crossref_metadata_2025_split huggingface dataset:
FOETUS IN FOETU
Authors: Pai K. Ramesh , Rao K. M. Lakshmana 
Published: January 2008

SummaryA case of foetus in foetu or included twin is presented. The operative findings and the anatomical features of the foetus are described in detail.An included twin is usually a monochorionic, diamniotic, monozygotic twin of its bearer, which was included within it during development. Hence, the correct age must be the age of the host as it starts its origin and the development at the same time as a host.Clinically a foetus in foetu usually presents as anabdominal mass with or without pressure symptoms. Radiographically a foetus in foetu may be diagnosed with ease. it should be different from soft tissue mass of renal origin such as Wilm's tumour hydronephrosis. Nephroblastomas and teratomas may contain calcification but they lack the organization of a foelus in foetu.A foetus in foetu should be removed because of the danger of infection or infarction if it is allowed to remain within its host. The mass may be removed in its entirety or the sac may be evacuated and left in situ.
The Absent Adult Gallbladder
Authors: Sherson N. D. 
Published: January 2008

The purpose of this report is to bring attention again to the rare condition of congenital absence of the adult gndlbladder without other congenital billiard tract abnormality, to present the only case recorded as such at the Royal Melbourne Hospital, to state the conditions that must be satisfied before the operative diagnosis is made, and to point out the need for permanent drainage of the common bile duct, which at the stage at which the abnormality is diagnosed is abnormal.Summary1. A further case of congenital absence of the adult gallbladder is reported.2. Before it is reasonable to make a diagnosis of congenital absence of the gallbladder at operation, one must have dissected the extra‐hepatic ductal system, palpated binianually the lesser omentum, falciform ligament and liver, probed suspicious areas of the liver (“sounding” for stone) and performed an operative cholangiogram, this latter being the most important, and indeed an essential, manceuvre.3. In young patients a drainage procedure, preferably biliary fenestration, is necessary to prevent continued symptoms and recurrent stone formation. In the older, more frailpatient, permanent T‐tube drainage may suffice.
Immunity in Cancer
Authors: Hunt P. S. 
Published: January 2008

Evidence from studies of experimental and human tumours confirms that the major component of the tumour rejection response is the circulating small long‐lived lymphocyte. In vivo antibody response to tumour antigen may result in enhancement of cancer growth rate, and possibly competes with cell‐mediated surveillance and rejection in the genesis of tumours. The host defect in cellular immunity which allows tumours to become established and grow is probably a general body phenomenon rather than one peripherally located in the draining lymph‐nodes. In the case of breast cancer this dysfunction is closely related to other endocrine factors. Immunotherapy remains an adjunct to other forms of treatment of solid tumours. The basis of immunotherapy requires maximum repression of cellular immune rejection, with simultaneous minimal production of potentially enhancing antibody.
Cervico‐ Dorsal Sympathectomy in the Management of Essential Hyperhidrosis in the Upper Limb
Authors: RENWICK STUART , LOEWENTHAL JOHN 
Published: January 2008

Essential hyperhidrosis of the upper limb is readily corrected by cervico‐dorsal sympathectomy. The clinical picture of this condition, the mechanisms of sweat production and the results of treatment are discussed.SummaryTreatment of essential hyperhidrosis of the upper limb in five patients by bilateral cervical sympathectomy is reported.There was no mortality and little morbidity in this series, and all patients were relieved of their distressing symptoms.
Thiersch's Operation1
Authors: WILSON EDWARD 
Published: January 2008

In the past 21 years Thiersch's operation has been revived and has earned a small but definite place among the operations now in use.SummaryThirsch's operation is the least disturbing procedure available for the treatment of complete rectal prolapse, and may be carried out no matter how poor the general condition of the patient.Despite the results in this series of 32 cases, it is my belief that Thiersch's operation (using a wide ring of braided stainless steel wire placed deeply in the perianal tissues) deserves a place in at least the poor‐risk case with a small but complete rectal prolapse.
Anterior Pylorectomy and Vagotomy for Complicated Peptic Ulceration
Authors: SCOTT PETER R. 
Published: January 2008

This article reviews the treatment of duodenal and gastric ulcer when complicated by hæmorrhage, performation and obstruction. Support is given for the use of anterior pylorectomy and vagotomy, carried out at the time when the emergency is dealt with, as the preferred long‐term procedure in the management of these conditions.Summary1. Bleeding duodenal ulcers are successfully treated by vagotomy and ligation of the bleeding point in combination with anterior pylorectomy and a personal series of nine cases illustrates this method. There are also certain advantages of such a conservative surgical approach over partial gastrectomy.2. The technique of anterior pylorectomy for bleeding cases differs slightly from that used for uncomplicated cases.3. Vagotomy with anterior pylorectomy for perforated duodenal ulceration is a safe and definitive operation. Its advantages over simple suture or emergency partial gastrectomy are indicated on the basis of a review of recent literature and of a small personal series.4. The technique of anterior pylorectomy for perforated cases differs slightly from that used for uncomplicated and bleeding cases.5. The treatment of obstructing duodenal ulceration by vagotomy and anterior pylorectomy may have a place. Pylorectomy, if considered inadequate, will not create technical difficulties with an ensuing gastrectomy.6. The place of vagotomy and anterior pylorectomy in complicated gastric ulceration and gastric erosions is uncertain, but it can be substantiated on present physiological knowledge.
Secondary Adamantinoma of the Ischium
Authors: LAW W. B. 
Published: January 2008

This case report describes secondary pelvic bone involvement by an uncommon bone tumour. Adamantmoma of the jaw accounts for only one per cent of all tumours in this area, and although gland and lung involvement have been described, bone involvement is rare.SummaryThe case of a patient with secondary bone involvement from adamantinoma of the maxilla is reported.
Traumatic Arteriovenous Fistula between the Internal Thoracic Artery and Vein
Authors: KETHARANATHAN V. , WESTLAKE G. W. 
Published: January 2008

The case is presented of a young male with a traumatic arteriovenous fistula between the internal thoracic vessels following a penetrating injury. The nature of the resulting cardiac bruit and its direction of radiation seemed to differentiate the condition from a persistent ductus arteriosus. This was confirmed by emergency aortography and appropriate surgical treatment was performed. The literature is reviewed and a few similar reported cases are quoted.SummaryA case of traumatic internal thoracic arteriovenous fistula is presented. The nature and site of the penetrating injury, the presence of a superficial continuous murmur conducted down‐ward and to the right, and an awareness of the occurrence of this condition following chest trauma suggested the diagnosis, which was confirmed by an immediate thoracic aortogram. The condition was cured by immediate surgery. Only four other cases of post‐traumatic fistulæ between the internal thoracic artery and vein have been found in the literature.
An Experimental Study on the Pathogenesis of Postoperative Hypoalbuminæmia1
Authors: CHANDRASEKHARAN N. 
Published: January 2008

This paper reports a study in the rat of the changes in the plasma albumin level following laparotomy, and their correlation with the concentrations of extravascular albumin in the area of the operation wound and in the liver.SummaryThe pathogenesis of postoperative hypoalbuminæmia remains a controversial and poorly understood topic. In the present study the changes in the plasma albumin level following laparotomy have been investigated by immunological methods and correlated with the concentrations of extravascular albumin in the operation wound site and in the liver.There was a fall in the plasma albumin level, accompanied by an increase in the extravascular albumin concentration at the laparotomy wound site, with no alteration in the concentration of albumin in the liver.This work confirms that postoperative hypoalbuminæmia is due to accumulation of albumin in the wound site. Increased capillary permeability is suggested as a cause of the excessive loss of plasma albumin into the surgically injured site.The role and subsequent fate of the extravascular albumin in the wound area are also discussed.
Rupture of the Duodenum Produced by a Safety Belt
Authors: BUXTON BRIAN 
Published: January 2008

The case report of a patient who sustained a traumatic rupture of the first part of the duodenum as a result of the restraint produced by a seat belt is presented. The literature on closed rupture of the duodenum is reviewed, and the possible mechanism of injury is discussed.SummaryA case of closed rupture of the first part of the duodenum as the result of injury due to the restraint produced by a safety belt is presented.The literature on closed rupture of the duodenum and seat belt injuries is briefly reviewed.The possible mechanisms of injury to the duodenum are discussed.The considered evidence in this case suggests that the body was thrown on to the loose safety belt, sustaining a blow to the right hypochondrium during a period in which the duodenum was distended, with the consequent production of explosive rupture of its first part.
Torsion of the Hydatid of Morgagni in the Female
Authors: KERN I. B. 
Published: January 2008

Torsion of the hydatid of Morgagni in the female is discussed, together with theories on embryology. A further case is presented, complicated by infarction of the tube and ovary.Summary1. The term hydatid of Morgagni is defined and its embryology outlined.2. A case of torsion of the hydatid leading to infarction of the tube and ovary is reported.3. The literature is reviewed.4. The more typical clinical features are presented, attention being drawn to referred pain.
Acute Spinal Epidural Abscess
Authors: LAW W. B. 
Published: January 2008

Acute spinal epidural abscess is described in two patients. In the patient in whom the abscess was recognized early and decompression effected a complete recovery of cord function occurred, whereas in the second case, where recognition and treatment were delayed, permanent damage was the end‐result. Severe back pain with evidence of infection must be checked frequently for neurological evidence of deterioration.Summary1. Two cases of acute spinal epidural abscess are reported.2. Complete recovery followed early drainage in one case.3. Late diagnosis in the second case was attended by a poor result.4. The development of severe pain in the back with signs of infection may merge almost imperceptibly with the onset of neurological signs and symptoms.
Open Heart Surgery in the Elderly1
Authors: SHANAHAN MARK X. , WINDSOR HARRY M. , GOLDING LEN 
Published: January 2008

A general reluctance to submit to open heart surgery elderly patients with acquired cardiac defects has wanned with increasing experience. Thirty‐five of 150 patients operated upon in 1971 were in fact over 60 years of age (23%). The first 100 elderly patients so operated upon have been selected for detailed study, and the results are presented. Results were excellent in patients with isolated aortic valve disease and coronary artery disease. They were satisfactory in those with isolated mitral valve disease, but generally disappointing following multiple valve procedures. It is considered that age alone should not be a contraindication to the proper selection of patients for cardiac surgery.SummaryThe results in 100 consecutive open heart procedures in patients aged 60 years of age and over are discussed. There has been a progressive increase in acceptance of the elderly patient as improvement in results has occurred. The results have been excellent in patients having isolated aortic valve replacement (8.5% early and 12% late mortality) and corrective procedures for coronary artery disease (no mortality). They were less satisfactory in patients having isolated mitral valve replacement (23% early and 16% late mortality), and were discouraging in patients having multiple valve replacement (25% early and 37% late mortality). The highe, mortality in these two groups is related to chronic mitral valve obstruction producing pulmonary disease, right ventricular failure and chronic systemic venous congestion. In the absence of such factors, age alone does not contraindicate open heart surgery.
SURGERY OF THE MITRAL VALVE: A PERSPECTIVE OF TWENTY‐FIVE YEARS
Authors: Windsor Harry M. 
Published: January 2008

This paper considers the changing concepts in management, and the results of surgery in 1000 isolated procedures on the mitral valve, during the past 25 years.The first 251 patients were managed by closed methods with an operative mortality of 4%, but with a high reoperation rate, at least 44% ultimately having valve replacement. Open methods were first used in 1960, 17 patients having conservative valvotomy without mortality, but with indifferent results. Valve replacement began in March, 1963, and since that time 615 mitral valve replacements have been carried out, in 433 of which it was an isolated procedure. The first 290 patients had replacement with a Starr Edwards ball valve prosthesis. The actuarial curve shows a survival rate of 70% at 5 years, 61% at 8 years and probably 50% at 15 years. The remainder, except for two, had replacement with disc valves, the first 65 with Bjork Shiley, and the last 76 with Lillehei Kaster prostheses. Four patients with Bjork Shiley prostheses developed thrombosis on the prosthesis, and this was a factor influencing the change to a LilleheiKaster prosthesis. The actuarial curve shows a survival rate of 86% at 4 1/2 years. Since March 1963, 171 patients have had conservative procedures with preservation of the valve; in 57 it was a blind procedure and in 114 it was an open procedure. There were no early deaths in these 171 patients, but there have been four late deaths. Twenty later came to valve replacement, 12 (20%) of them being in the closed gr'oup and 8 (7%) in the open group. One hundred and twenty‐eight (74%) are considered to be Grade I or II, most of these being in the open group.
EVALUATION OF AN INTRAOPERATIVE TEST FOR THE COMPLETENESS OF VAGOTOMY
Authors: WILLIAMS R. S. , JOHNSON A. G. 
Published: January 2008

An intraoperative test for the completeness of vagotomy has been evaluated in 103 consecutive operations, including proximal gastric, selective and truncal vagotomies, and truncal vagotomy with antrectomy. At the completion of the vagotomy a pH probe was used to test gastric mucosal response to an intravenous infusion of pentagastrin, aiming to detect undivided vagal fibres by localizing residual areas of acid secretion.Testing was performed in 86 out of 103 vagotomies, and in only 34% was the vagotomy judged complete at the first attempt. Residual areas of acid secretion (usually small) were detected in the remainder, and in nearly all of these it was possible to abolish these areas by dividing further vagal fibres.It is suggested that intraoperative pH testing improves the likelihood of a complete vagotomy, the test is also useful to plot precisely the antral‐body junction when antrectomy is combined with vagotomy.
THE INCIDENCE AND MANAGEMENT OF CHYLOUS FISTULAE
Authors: Havas ThomasE. , Gullane PatrickJ. , Kassel RobertN. 
Published: January 2008

Two hundred neck dissections performed at toronto general hospital over a 3 year period are reviewed. There were six intra‐operative lymph leaks and five postoperative chylous fistulae. The postoperative chylous fistulae are analysed in detail and the approach to conservative management of lymph leaks is discussed.Two cases required re‐exploration of the neck; difficulty in identifying the site of leakage and of sealing lymph channels is discussed. Also reported is the successful use of topical tetracycline powder in two cases and a review of the various treatment modalities advocated in the literature.
THE EPIDEMIOLOGY AND PREVENTION OF CANCER IN AUSTRALIA
Authors: Armstrong Bruce K. 
Published: January 2008

Based on the numbers of new cancers diagnosed, deaths from cancer and person‐years of life lost as a result of death from cancer, non‐melanocytic skin cancer, lung cancer, cancers of the colon and rectum, breast cancer, cancer of the prostate, melanoma, cancer of the stomach, cancer of the bladder, cancer of the pancreas, and non‐Hodgkin's lymphoma were judged to be the most important cancers in Australia in 1982. Of these, only cancer of the pancreas appeared to be decreasing in frequency, and then only since 1979. while cancers of the lung and malignant melanoma of the skin were increasing rapidly. By the tum of the century the number of new cases of cancer diagnosed in Australia each year will be at least 50% higher than it was in 1982, mainly as a result of population growth and ageing.Given what is presently known about the causes of cancer it may be estimated that about one‐third of cancers occurring in Australia could be prevented through feasible programmes. More than half of this change would be achieved through the elimination of tobacco smoking. A further 13% of cancer deaths, and some non‐fatal cases, could be prevented by the effective implementation of cancer screening programmes of established efficacy. Even after this, however, many of the currently important cancers would remain significant. They are. therefore, priority subjects for research in cancer control.
HEPATIC TRAUMA IN AUCKLAND
Authors: Douglas R. G. , Holdaway C. M. , Shaw J. H. F. 
Published: January 2008

A retrospective review of 102 cases of hepatic trauma in the Auckland area between 1979 and 1985 is presented. Particular attention has been focused on those cases where there was massive bleeding, and the prognostic factors that govern outcome have been determined.Mechanism and multiplicity of injury, and the presence of severe hypotension (systolic blood pressure < 80 mmHg) either at presentation or following induction of anaesthesia were the four most important determinants of prognosis. Blunt trauma caused 82% of these cases, with the mortality in this group being 27%. compared with 6% for penetrating trauma cases. The mortality of those patients who presented with a systolic blood pressure < 80 mmHg was 44% compared with 13% for those whose blood pressure was above 80 mmHg. Thirteen patients sustained severe bursting or avulsion‐type injuries, in eight of whom extensive resection of formal lobectomy was performed with a survival of 88%. The remainder exsanguinated either pre‐operatively (two patients) or before definitive hepatic surgery was begun (three patients). All patients with caval or retrohepatic venous injuries exsanguinated either pre‐ or intra‐operatively.It is concluded that the mortality of liver injury from blunt trauma far exceeds that of penetrating trauma, and that severe hypotension at the time of presentation indicates a poor prognosis. A good outcome is possible in those patients who have a significant disruption of the liver architecture of one lobe following resection of devitalized tissue. Caval or retrohepatic venous‐type injuries carry a grave prognosis.
HUCKSTEP NAIL ARTHRODESIS OF THE KNEE: A SALVAGE FOR INFECTED TOTAL KNEE REPLACEMENT
Authors: Goldberg JeromeA. , Drummond RobertP. , Bruce WarwickJ. M. , Viglione Wayne , Lennon WilliamP. 
Published: January 2008

Seventeen patients had huckstep nail arthrodeses of the knee as a salvage for infected total knee replacements. All patients were followed prospectively for an average of 22.6 months. All patients were satisfied with their results. There was one broken nail secondary to non‐union, and three other patients with non‐unions (two of whom were asymptomatic).It is believed that this is a reliable method of treatment in selected patients. It has a number of advantages over other techniques. In addition, a two‐staged operative method with a number of technical improvements is outlined.
SPLENECTOMY FOR TRAUMA: MORBIDITY, MORTALITY AND ASSOCIATED ABDOMINAL INJURIES
Authors: Pitcher M. E. , And R. J. Cade , Mackay J. R. 
Published: January 2008

Management of ruptured spleen still frequently requires splenectomy. A retrospective analysis of patients undergoing spleneelomy for trauma at box hill hospital, melbourne, over a 14‐year period was conducted; 141 of 145 cases were due to blunt trauma. The mortality rate was 10% and all deaths occurred as a result of road traffic accidents. The overall complication rale was 43%, varying from 25% in those with an isolated splenic injury to 100% with multiple system injuries.There was zero incidence of associated intra‐abdominal injury in the group sustaining a ruptured spleen as a result of a fall, assault or sporting injury, in contrast to a nearly 50% incidence following road traffic and bicycle accidents. Whether these associated injuries would have been neglected had laparotomy for splenic trauma not been performed is uncertain, and so non‐operative management of splenic trauma remains contentious, particularly in cases following vehicular accidents.
DESIGN AND TRIAL OF A METRONIDAZOLE LOADING DOSE REGIMEN FOR PATIENTS UNDERGOING EMERGENCY SURGERY
Authors: Ioannides‐Demos L. L. , Farmer C. , Spicer W. J. , McLean A. J. 
Published: January 2008

A dosing regimen for administration of metronidazole to patients undergoing emergency surgery was designed using pharmacokinetic data.Computer estimates of the pharmacokinetic parameters from normal volunteers were used to determine a loading dose protocol that would achieve plasma metronidazole levels above 6.2 μg/mL, that is, above the minimum inhibitory concentration (MIC) of most pathogenic anaerobic bacteria, at the time of surgery. The protocol aimed to identify the minimum intravenous metronidazole dose in combination with a rectal suppository regimen. This was calculated to be a 1 g (two 500 mg) metronidazole rectal suppository dose administered when the decision to operate was made, followed by a 200 mg intravenous dose at the induction of anaesthesia if the time to surgery was within 1–8 h.This protocol was tested in 10 patients undergoing emergency abdominal/pelvic surgery. All patients in the trial were found to have levels well above the MIC at the time of surgery (mean = 17.06 μg/mL, s.d. = 4.76).It is concluded that appropriate use of metronidazole suppositories can minimize intravenous dosage requirements for metronidazole under conditions of emergency loading as well as elective surgery.