bluuebunny/crossref_metadata_2025_split huggingface dataset:
LAPAROSCOPIC CHOLECYSTECTOMY INITIAL EXPERIENCE
Authors: Jones R. M. , Fletcher D. R. , MacLellan D. G. , Lowe A. W. , Hardy K. J. 
Published: January 2008

Twenty‐five consecutive patients underwent percutaneous laparoscopic cholecystectomy (PCC). The gallbladder was removed successfully in 18 patients. The mean postoperative hospital stay was 1.4 days and patients returned to normal activity at a mean 8 days after operation. Postoperative pain was minimal. Formal laparotomy was performed in 7 patients due to: bleeding (3 patients), stone spillage (3 patients) and exploration of the common bile duct (1 patient). Complications were reduced with experience and strict adherence to the described operative technique.With obvious advantages for the patient, hospitals and the community an increased demand for PCC is inevitable. However, its role in the management of cholelithiasis and overall safety have yet to be determined. There is a significant learning curve and proper training is necessary. The widespread introduction of PCC has immediate implications for surgical training.
LEVELS OF COMPLEMENT FACTOR C3 AND ITS ACTIVATED PRODUCT, C3a, IN OPERATIVELY SALVAGED BLOOD
Authors: Sieunarine K. , Wetherall J. , Lawrence‐Brown M. M. D. , Goodman M. A. , Prendergast F. J. , Hellings M. 
Published: January 2008

In intra‐operative blood salvage the collected blood is exposed to traumatized tissue and a synthetic circuit. Because of this exposure it was expected that the complement system, which is a contact system present in plasma, would be activated in salvaged blood. To determine whether this occurs, the plasma levels of the complement factor C3 and its activated fragment, C3a, were measured in intra‐operative salvaged blood before and after washing. Samples were obtained from patients undergoing aortic surgery where intra‐operative salvage was used. In the unwashed salvaged blood, the level of C3 fell (mean C3: 0.33 g/L) and the level of C3a increased (mean C3a: 1994 ng/mL) compared with the patient circulating levels of C3 and C3a (mean C3: 0.70g/L, mean C3a: 855 ng/mL) respectively. Washing of the collected blood reduced the C3a level (mean: 346 ng/mL) to the patient's level and reduced C3 to the lower detection limit of the test (< 0.2 g/L).The raised level of C3a and the reduced level of C3 confirm that the complement system is activated and imply that other complement factors are also activated.
PLATELET FUNCTION IN THE PERI‐OPERATIVE PERIOD
Authors: Cooper T. M. , Ingram D. M. 
Published: January 2008

Although platelets have an important role in haemostasis and in thrombosis, what happens to platelet function postoperatively is not well understood. We investigated platelet function in the perisperative period by measuring total platelet count and several products released by activated platelets, thromboxane, betathromboglobulin and lyso‐platelet activating factor (lyso‐PAF).The only changes detected were a significant rise in total platelet count between 48 h and 5 days postoperation, and a progressive fall in lyso‐PAF up to 48 h post‐operation. It is possible that other changes may have occurred, but were an immediate effect and were not apparent at time of the first blood sample 2–3 h post‐operation.
INTUSSUSCEPTION IN NEWCASTLE IN A 25 YEAR PERIOD
Authors: Tangi V. T. , Bear J. W. , Reid I. S. , Wright J. E. 
Published: January 2008

The history of intussusception in Newcastle in a quarter of a century is presented by analysis of patient presentation and the results of management. The figures for the early years are incomplete, retrieved from one hospital in the area. For the years 1976–1988, all cases were managed by two paediatric surgeons who kept individual disease indices. One hundred and sixty‐five episodes of intussusception in 153 patients were reviewed in this study. There was one death in the series, whereas there had been several in the years preceding it. There has been an improvement in the success of hydrostatic and later pneumatic reduction. These changes are attributed to the development of appropriate skills resulting from concentration of the management of this problem in the hands of paediatric surgeons and radiologists with special training and interest in paediatrics. Enema reduction has been used more aggressively in recent years and has widened criteria.In the series there were 8 patients with causal lead points, none associated with recurrence. The overall recumence rate within the series was estimated at 8%. There seems to be a high incidence of intussusception in doctors' families.
PRIMARY CARCINOID TUMOUR OF THE ILEUM ASSOCIATED WITH MASSIVE GASTROINTESTINAL HAEMORRHAGE
Authors: Miller G. A. , Borten M. M. 
Published: January 2008

A case of massive gastrointestinal haemorrhage due to a 3 mm primary carcinoid tumour of the ileum is described. Previously described instances of this problem have been due to larger tumours. The site of the haemorrhage was suggested by a technetium‐labelled RBC isotope scan. The lesion was visualized by ‘on‐table’ endoscopy via the colon and ileo‐caecal valve.The patient did well after segmental resection of the lesion. This case highlights the diagnosis and current approach to massive lower gastrointestinal haemorrhage.
PROGNOSTIC SIGNIFICANCE OF NUCLEAR DNA CONTENT IN PHAEOCHROMOCYTOMA
Authors: Cope Charles , Delbridge Leigh , Philips Eanette , Friedlander Michael 
Published: January 2008

Nuclear DNA content of 27 phaeochromocytomas was measured by image analysis of thin sections and monolayer smears of nuclei extracted from thick sections (cytospins) using archival paraffin‐embedded tissue blocks. Recurrence was assessed on the basis of clinical follow‐up or urinary catecholamine levels. The mean follow‐up was 5.0 years, with a range of 4 months to 15 years.Although it is not possible to differentiate accurately malignant tumours using DNA analysis, prediction of benign tumours is possible. Using thin sections, all tumours were benign when the percentage of cells with a DNA content of 2.5 c (2 c = diploid) was less than 40% and the DNA content of 5 c was less than 4%. Using the cytospin preparation, all diploid tumours were benign. Thus, patients with diploid tumours may be saved intensive long‐term follow‐up. Aneuploid and tetraploid tumours, however, continue to require careful lifelong follow‐up.
PERI‐OPERATIVE MORTALITY IN HEPATIC RESECTION
Authors: Tjandra J. J. , Fan S T. , Wong J. 
Published: January 2008

The operative results of hepatic resections (n= 67) during the past 28 months are reported. Major hepatic resection (lobectomy, extended lobectomy) was performed in 78% of patients with hepatocellular carcinoma (HCC) and in 24% of patients with non‐HCC diseases. The overall operative mortality was 10%: 15% for HCC and 0% for non‐HCC diseases. The operative mortality in the HCC group occurred exclusively in patients who had undergone right or extended right lobectomy. The operative mortality of right or extended right lobectomy in patients with HCC increased considerably with the presence of cirrhosis (32%vs 0%) and a liver function worse than Child's A (60%vs 17%).In HCC, the incidence of operative mortality (47%) and postoperative hepatic failure (73%) was higher when there had been massive operative blood loss ( 4.0L) and/or persistent postoperative haemorrhage, compared with 0% and 24% respectively in cases without massive peri‐operative bleeding. While postoperative hepatic failure was present in 5 of 7 fatalities. it was not an independent prognostic factor, but was dependent on the presence of massive peri‐operative blood loss.
THE COMMON BILIO‐PANCREATIC CHANNEL SYNDROME IN CHILDHOOD
Authors: Barker A. P. , Ford W. D. A. , Quesne G. W. Le , Moore D. J. 
Published: January 2008

An abnormally long common bilio‐pancreatic channel has been found in association with choledochal cysts and biliary strictures in childhood. It may also present with recurrent abdominal pain, vomiting, hyper‐amylasaemia and jaundice. This has been termed the common channel syndrome (CCS).Two cases with the CCS presenting early in childhood are reported together with a review of the literature. Open sphincteroplasty was performed in both cases with a satisfactory outcome.
EXTRADURAL MALIGNANT LYMPHOMA ASSOCIATED WITH SPINAL CORD COMPRESSION
Authors: Crowley K. S. , Miliauskas J. , North J. B. , Esterman A. , Leong A. S‐Y. 
Published: January 2008

Cord compression was noted in 26 patients with extradural malignant lymphoma. There were 19 cases of non‐Hodgkin's lymphoma and seven cases of Hodgkin's disease. Eighteen cases of non‐Hodgkin's lymphoma had intermediate or high grade malignancy types according to the Working Formulation Lymphoma Classification. These patients represented 28% of all extradural malignant tumours seen at the Royal Adelaide Hospital (RAH) and 2.5% of all patients with malignant lymphoma, during an 11 year period.The patients were classified in three presenting groups: Group A, six patients with primary extranodal extradural lymphoma; Group B, nine patients with bolh extradural lymphoma and disseminated disease at initial presentation; and Group C, 11 patients who developed extradural lymphoma during the course of established disease. Only classification by groups appeared to affect survival time. Group A had the most favourable prognosis, with a 5 year survival of 83%. Five of the Group A patients had a relapse of lymphoma; four at distant sites and one in the retroperitoneum. Laminectomy was essential to provide a diagnosis in Group A patients. The most useful warning symptom of impending spinal cord compression was back and/or radicular pain, which preceded neurological deficit either by days or by up to 5 years. Plain spinal X‐rays were abnormal in 64% of cases, emphasizing the value of this simple procedure.
THE TREATMENT OF DISSEMINATED PROSTATE CANCER WITH ESTRAMUSTINE
Authors: Rosenthal M. A. , Raghavan D. , Stuart‐Harris R. , Ackland S. , Grygiel J. 
Published: January 2008

Forty‐three patients with disseminated prostate cancer, resistant to orchidectomy or hormone therapy with estramustine were treated. Of the 33 evaluable patients, three patients had stable disease and two had a partial tumour response according to National Prostatic Cancer Project criteria. Twenty‐five patients (58%) showed improvement in pain and urinary symptoms. Ten patients (23%) had side effects requiring cessation of therapy.These results show that estramustine has a limited role in the treatment of advanced prostate cancer and that therapy is frequently associated with intolerable side effects.
ROLE OF THE PRE‐TEST IN THE PROGRESSIVE ASSESSMENT OF MEDICAL STUDENTS
Authors: Hill David A. 
Published: January 2008

A prospective, randomized, controlled trial was conducted to see if a pre‐test, given immediately before teaching, improved performance in a subsequent post‐test. The study was also used to assess the educational value of a structured teaching method.Third year medical students were randomized into study and control groups. In phase I, the study group completed a subject‐specific multiple choice question (MCQ) pre‐test immediately before a teaching demonstration on vascular disorders. The control group completed a placebo pre‐test. At the completion of teaching both groups did the same subject‐specific post‐test. The experiment was repeated in phase II where the groups were crossed over and traumatology was the subject of the demonstration.In both phases of the experiment there were no significant differences between the post‐test marks of the experimental and control groups (P= 0.128 and 0.397, respectively). The experimental groups did, however, increase their marks significantly when their post‐test results were compared with pre‐test marks (P≤ 0.0001. phase I and II).It was concluded that the pre‐test did not result in a measurable increase in learning. The study did demonstrate that the teaching method was effective as post‐instructional knowledge increased by nearly half when compared with pre‐test levels.
TOTAL LARYNGECTOMY WITH PRIMARY VOICE RESTORATION
Authors: Cole IAN , Miller STUART 
Published: January 2008

Forty‐three patients were prospectively studied following tracheo‐oesophageal puncture at the time of laryngectomy (primary voice restoration). Blom‐Singer voice prostheses were used.The surgery was regarded as successful if a patient continued to use the voice prosthesis as the major means of communication with clear intelligibility 4 months after the operation. Using this criterion, the success in this series was 70%. No attempt was made to assess the quality of speech. Complications and causes of failure are discussed.
INVESTIGATION, FOLLOW‐UP AND RECURRENCE AFTER RESECTION OF COLORECTAL CANCER
Authors: McLeish John A. , Giles Graham G. , Thursfield Vicky 
Published: January 2008

A study was undertaken to determine the patterns of management in the 2 years following resection of colorectal cancer by Victorian surgeons. Patients were identified by the Victorian Cancer Register as having colorectal cancer diagnosed between 1 July and 31 December 1987. The surgeon of each of the 947 eligible patients who underwent surgery was sent a questionnaire seeking information about the pre‐operative investigation. type of surgery and subsequent line of referral. Only 16% of colonic cancers and 39% of rectal cancers were biopsied pre‐operatively and colonoscopy was undertaken in one‐half and one‐third respectively. Of the 737 responses, 555 patients were considered to have had curative surgery, and details of their follow‐up during the four 6‐month periods following surgery was analysed; this includes the effect of tumour stage and surgeon activity on the use and frequency of each test. Most patients had a clinical examination in each of the 6 month periods, but almost half did not have a colonoscopy and two‐thirds did not have the serum CEA level measured at all. Only one in eight had a chest X‐ray and fewer had the liver scanned during this 2 year period.Eighty‐two patients (20% of those satisfactorily followed) suffered a recurrence during this period. Twenty‐six were asymptomatic at the time of recurrence and were diagnosed by a routine test and of these, eight were diagnosed by tests used infrequently. Sixteen (20%) were considered surgically curable.
CARCINOMA OF THE THYROID GLAND AND GARDNER'S SYNDROME
Authors: Kelly Michael D. , Hugh Thomas B. , Field Andrew S. , Fitzsimons Ross 
Published: January 2008

A patient known to be suffering from Gardner's syndrome who developed carcinoma of the thyroid gland is presented. A review of the literature reveals that this relationship is not fortuitous and that it has the following characteristics: female predominance (89%), youth (< 30 years in 78%), papillary form (88%), multicentricity (70%) and thyroid carcinoma preceding diagnosis of hereditary polyposis in 30%.Hereditary polyposis patients affected by familial polyposis coli are at significant risk of developing extracolonic malignant tumours, and require life‐long surveillance. Palpation of the thyroid gland and possibly ultrasound examination of the neck should be part of the routine follow up of these patients.
ATTITUDES TOWARDS LIVER TRANSPLANTATION IN VICTORIA, AUSTRALIA
Authors: Hardy K. J. , Milton P. , Derham P. , Fletcher D. R. , MacLellan D. G. , Jones R. McL. , Shulkes A. 
Published: January 2008

Liver transplantation commenced on a regular basis in Australia in 1985. This followed the first succcssful orthotopic transplant in Brisbane in 1985 and the setting up of a National Centre for Liver Transplantation in Sydney in 1985 with clinical transplantation beginning there in 1986. A centre was subsequently developed in Melbourne in 1988. As this procedure was perceived to be expensive, and because of discussion on rationing of medical services, the authors were prompted to test the Victorian community awareness and attitude to government funding of transplantation.One year after the establishment of the Victorian Liver Transplantation Programme, a random survcy of the Victorian population and of general practitioners in Melbourne was conducted with the assistance of a professional polling company. Sixty‐five pcr cent of the Victorian population knew livcr transplantation was available in Victoria, 12% said it was not available and 23% did not know. Among general practitioners, 79% knew liver transplantation was available 14% said it was not availablc and 7% did not know. Eighty‐eight per cent of Victorians and a similar proportion of general practitioncrs said the State Government should provide funding. Forty‐seven per cent of the Victorian population said government should provide total funding and a further 39% funding of more than 50%. Among general practitioncrs, 33% said total funding should be provided and a further 46% thought that more than 50% of funding should be provided.This survey has revealed convincingly that Victorians have decided that their health carc should include the expense of liver transplantation paid for by government. Awareness of the availability of thc operation of liver transplantation is developing rapidly.
ONCOCYTES OF THE THYROID: A NEUTRAL RED DYE UPTAKE STUDY
Authors: Bay B. H. , Sit K. H. , Pang A. S. 
Published: January 2008

Oncocytosis and oncocytomas have attracted attention because on the one hand there have been reports of the favourable prognosis and generally benign nature of oncocytic tumours, while on the other hand, Hurthle cell change in thyroid neoplasms have been reported to be correlated with aggressive biological behaviour and a significantly worse clinical course. Presently, there appear to be two schools of thought on the significance of oncocytosis: (i) a process where there is redifferentiation of cells with involvement in the pathogenesis of cancer; and (ii) a compensatory process for ‘functional exhaustion’ of the cell. Many aspects of oncocytosis seem unclear.In this study, transmission electron microscopy is used to demonstrate the presence of thyroid oncocytes in the hemithyroidectomy specimen of a patient with focal lymphocytic thyroiditis. Tissue sections from this specimen did not display preferential uptake of neutral red dye, a distinctive characteristic of M‐phase cancer cells which was previously reported. The findings seem to suggest that oncocytes are not cells with distinctive proliferative potentials. If that were the case, then oncogenesis or cancer cell progression and oncocytosis may not be convergent processes.
COMMON BILE DUCT CALCULI AT LAPAROSCOPIC CHOLECYSTECTOMY: A TECHNIQUE FOR MANAGEMENT
Authors: Fletcher David R. 
Published: January 2008

Laparoscopic cholecystectomy was attempted in 150 unselected patients. The use of routine intra‐operative cholangiography prevented serious bile duct injury in one patient. It also showed 75% of patients suspected pre‐operatively of having common duct stones, had passed them by the time of cholecystectomy. Eight of 12 diagnosed duct stones (5 suspected, 7 unsuspected) were removed laparoscopically. A technique is described using inexpensive and readily available equipment that allows the transcystic duct treatment of the majority of common duct stones.The development and use of such techniques to laparoscopically treat duct stones will once more allow surgeons to treat all biliary calculi at the one procedure and reduce unnecessary dependence on endoscopic retrograde cholangiopancreatography/sphincterotomy.
THE PROBABILITY OF PASSING AT RESITS IN THE PART I FELLOWSHIP EXAMINATION
Authors: Bandaranayake Raja C. , Buzzard Anthony J. 
Published: January 2008

The study aimed to determine the relationship of a candidate's attempt number and proximity of the aggregate score to the pass mark, individually and in combination, to the probability of passing at the next attempt at the Part I FRACS examination. The results of 36 examinations, in which 3513 candidates sat 5891 tests, were analysed. While 40.5% of all candidates who sat these examinations passed, the first attempt pass rate was 44%. Overall about one‐third of the candidates who had sat the examination previously passed at the next attempt, the probability of passing remained fairly constant up to the fourth attempt and fell thereafter. As expected, the further the candidate's aggregate score was below the pass mark, the lower the probability of passing at the next attempt. Considering both attempt number and proximity to the pass mark, probability of passing decreased with successive attempts except for very weak candidates.The results indicate that, while the imposition of an upper limit on the number of resits at the examination is not justified, candidates who fall significantly below the pass mark should be advised against resitting for a reasonable period, and those who repeatedly do so should be advised to seek another career. It is suggested that feedback to the candidates about the probability of passing at the next attempt be based on the results obtained in this study.
INJURIES OF THE DISTAL FEMORAL GROWTH PLATE AND EPIPHYSIS: SHOULD OPEN REDUCTION BE PERFORMED?
Authors: Edmunds Ian , Nade Sydney 
Published: January 2008

A retrospective study for the period 1978–91 revealed 33 patients with fractures involving the distal femoral growth plate and epiphysis. Treatment by closed reduction and casting resulted in a high rate of loss of position. Twenty‐three of the patients were followed up for an average of 4.8 years. Salter‐Harris type II fractures predominated. An analysis of this group showed that treatment by open reduction and internal fixation gave better results than closed reduction and casting, or percutaneous fixation.The authors advocate treating all displaced Salter‐Harris type II, III and IV fractures by open reduction and internal fixation. If closed means are employed, extra care needs to be taken in short‐ and long‐term follow up, and the patient and parents advised of the likelihood of loss of position, deformity and/or growth disturbance.
DISCOGENIC COMPRESSION OF THE CAUDA EQUINA: A SURGICAL EMERGENCY
Authors: Dinning T A. R. , Schaeffer H. R. 
Published: January 2008

The syndrome of cauda equina compression due to central disc rupture is uncommon but its importance greatly transcends its rarity. Key symptoms and signs are bilateral leg pain, weakness or numbness (although unilateral symptoms or even absence of leg pain do not exclude the diagnosis), perineal numbness and, in 60% of patients, bladder and bowel incompetence ranging from dysuria to vesid and anal sphincter paralysis.Diagnosis and treatment are often delayed due to lack of recognition of the condition and failure to appreciate the surgical imperative for its treatment. At the present time myelography is the one essential investigation, although this may become supplanted in time by magnetic resonance imaging. Arrangements for myelography should be planned so that immediate operation can be commenced following the procedure.The onset of disc rupture may be acute and massive and result in intradural sequestration of disc fragments in 7.5% of cases. Intradural exploration and/or transdural sequestrectomy avoids traction on already compromised nerve roots and is often safer than extradural sequestrectomy.The onset of bladder paralysis is a most important indication for immediate surgery. The cases presented show that there is a highly significant difference in the outcome of those cases operated on within 24 h of bladder paralysis compared to those operated on after this period.