bluuebunny/crossref_metadata_2025_split huggingface dataset:
HP30P A COMPARISON OF 4 DIFFERENT PROPRIETARY GASTRIC BANDS
Authors: Cheng A. K. S. , Poon P. L. , Tan K.Y. , Rao A. , Lim E. , Ramalingam G. 
Published: April 2007

LapBand surgery is fast becoming a favorite procedure for the surgical treatment of morbid obesity. That gastric restriction by banding is efficient in weight and co‐morbidity reduction is well established. Certain short and medium term morbidities have also been identified.There are several popular brands of bands available on the market. They can be low volume high pressure; or high volume low pressure. Each of these brands has their own champions.Alexandra Hospital in Singapore has the largest single institution experience in gastric banding procedure in South East Asia. Information relating to Asian patients undergoing gastric banding using different proprietary bands is so far not available.We carried out a small prospective study of 4 different proprietary bands. The average follow up is 12 months. Weight reduction, short‐term complications, and other surgical issues are address with respect to these different bands.The result is presented.
HP31P USE OF BIB INTRA‐GASTRIC BALLOON IN ASIAN PATIENTS
Authors: Cheng A. K. S. , Poon P. L. , Tan K. Y. , Rao A. , Lim E. , Ramalingam G. 
Published: April 2007

The BIB intra gastric balloon is a popular form of non‐surgical intervention in the management of morbid obesity. This is either used in isolation or as part of a staged bariatric procedure. Large series of BIB intervention has been reported in the literature. Report on use in Asian patients is uncommon.Alexandra Hospital in Singapore has the largest single institution experience in Bariatric intervention. Gastric banding is the most commonly carried out procedure in Singapore.We report a small series of BIB intervention in Singapore patients.Results including efficacy of weight and co‐morbidity reduction, short‐term morbidities, potential for weight regain after removal of the balloon, is reported.
HP36P DOES NEO‐ADJUVANT CHEMOTHERAPY AFFECT THE ACCURACY OF HELICAL CT AND CT PORTOGRAPHY FOR PRE‐OPERATIVE PLANNING IN HEPATIC COLORECTAL METASTASES?
Authors: Adie S. , Yip C. , Chu F. , Morris D. L. , Modi D. 
Published: April 2007

Purpose  Pre‐operative scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of neo‐adjuvant chemo, which has marked biochemical & physical effects on the liver. We investigated helical CT and CT portography as pre‐op planning tools.Methodology  All patients who had resection of hepatic colorectal metastases between Jan 2004 and June 2006 were included. Patients were divided into those who received neo‐adjuvant chemo and those who did not. The number of malignant hepatic lesions found on each scan was compared with those found on histopathology & intra‐op ultrasound/examination. Accurate scans (scan lesions = true lesions), over‐estimations (scan lesions > true lesions) and under‐estimations (scan lesions < true lesions) were recorded.Results  25 patients had pre‐op CT portography with neo‐adjuvant chemo and 63 without. Accurate scans on a per‐patient basis were 2 (8%) for the chemo group vs. 27 (43%) for the non‐chemo group, p < 0.002. Notably, there were 17 (68%) over‐estimates in the chemo group vs. 25 (40%) in the non‐chemo group. There were 6 (24%) vs. 11 (17%) under‐estimates respectively. 23 patients had pre‐op helical CT with neo‐adjuvant chemo and 64 without. Accurate scans on a per‐patient basis were 7 (30%) for the chemo group vs. 26 (41%) in the non‐chemo group, p = 0.388. There were 8 (35%) over‐estimates in the chemo group vs. 12 (19%) in the non‐chemo group. There were 8 (35%) vs. 26 (41%) under‐estimates respectively.Conclusion  While CT portography is useful for detecting occult hepatic metastases, there is evidence that over‐estimation of disease is a problem, particularly when neo‐adjuvant chemo was used. Helical CT also shows this trend although to a lesser extent.
HP39P USE OF THE SUPERFICIAL FEMORAL VEIN AS A CONDUIT FOR PORTAL VEIN RECONSTRUCTION DURING PANCREATICODUODENECTOMY
Authors: Gillespie C. , Jauffret B. 
Published: April 2007

One of the challenging and controversial aspects of pancreatic surgery is the management of tumours adherent to the superior mesenteric and portal veins (SMPV). Options include venous resection with patch or primary closure and reconstruction of the portal vein with autogenous or synthetic conduits. The internal jugular vein has been popular.The use of the superficial femoral vein (SFV) has been reported recently. It is well established as a conduit in various other scenarios, mainly in the reconstruction of a neoaortoiliac system for infected prosthetic aortic grafts. Its large calibre, good handling properties, high patency rate, and resistance to infection are characteristics that make it excellent for both venous and arterial substitutes. Experience has shown that it can be harvested with minimal venous morbidity in the donor limb.We present a case of complete encasement of the SMPV by a slow‐growing pancreatic tumour. Significant dilatation of the common bile duct and pancreatic duct along with chronic pancreatitis in the tail facilitated resection. Mesenteric venous return was collateralized to haemorrhoidal portosystemic shunts via ileocaecal and pericolic veins and a very large inferior mesenteric vein (IMV).Venous excision included portal vein to 5 mm below the bifurcation, 10 mm of splenic vein and 15 mm of superior mesenteric vein. As the splenic vein was well drained to the IMV, only the superior mesenteric vein was reconstructed with an end to end bypass to the portal vein using SFV.The superior handling properties, similar calibre to the portal vein, and low morbidity of SFV harvest of this length make it an attractive option as a conduit for portal vein reconstruction during pancreaticoduodenectomy.
HP04 LIVER RESECTION: A REGIONAL HOSPITAL EXPERIENCE
Authors: Yong T. , Bohmer R. , Pande G. , Hewitt P. M. 
Published: April 2007

Purpose  Liver resection is a significant operation usually limited to large metropolitan hospitals. We first started performing liver resections at the Launceston General Hospital (LGH) which is a regional centre (bed capacity 280), in 2000. This is a summary of our experience.Methodology  Data of liver resections performed between May 2000 and January 2007 at the LGH, was collected prospectively and reviewed with particular attention to patient survival, post‐operative complications and disease recurrence.Results  There were 79 consecutive liver resections during the study period. All of these were done using intra‐operative ultrasound to determine resection margins and an ultrasonic dissector, together with portal inflow control. Metastatic colorectal adenocarcinoma was the most frequent pathology (n = 49). Six patients had metastases from primaries other than colorectal cancer. There were 13 resections for primary liver/ biliary malignancy; 1 for contiguous invasion by gastric cancer and 10 were for benign conditions. Minor bile leak was the most common procedure‐related complication (21 patients; 27%). No patients had reactionary/secondary haemorrhage. There were four deaths in‐hospital: 2 liver failure, 1 septicaemia, 1 PE (surgical mortality 5%). At the time of this audit, 41 cancer patients are disease free; 9 are alive with disease and 16 have died (14 from recurrent disease).Conclusion  Resection provides the best hope of cure for patients with primary or secondary hepatic malignancy. With adequate expertise liver resections can be performed safely in a regional hospital.
HP05 BETA IS BETTER THAN RADIOFREQUENCY ABLATION
Authors: Dobbins C. , Wemyss‐ Holden S. , Cockburn J. , Maddern G. 
Published: April 2007

Purpose  Radiofrequency ablation (RFA) is a popular method of treating unresectable liver tumours by the use of a high‐frequency, alternating electrical current that heats and destroys tumour cells. The size of the ablation produced is limited by localised charring of adjacent tissue that prevents further conduction of the radiofrequency current. To overcome this problem, a Bi‐modal Electric Tissue Ablation (BETA) circuit has been created that adds a direct electrical current to a radiofrequency current. Direct currents attract water to the cathode in biological tissues and this phenomenon is utilised in an effort to prevent tissue charring. The BETA circuit was tested in a pig model.Methods  2 studies have been performed with this new circuit, one to compare sizes of the ablation produced between standard RFA and the BETA circuit. This was followed by a long‐term study to assess associated changes to liver function and pathological changes within the liver.Results  Ablations with significantly larger diameters are created with the BETA circuit (49.6 mm +/− SE 3.46 vs 27.78 mm +/− SE 3.37, p < 0.001). Ablations produced by the BETA circuit induced coagulative necrosis within the treated hepatocytes that healed by fibrosis. Significant rises in serum liver enzymes are seen within 24 hours of treatment but these return to normal within 7 days. Treatment with the BETA circuit otherwise appears safe.Conclusions  The BETA circuit produces significantly larger ablations than standard RFA. Although larger, the injuries produced behave in a similar manner to standard RFA and it is anticipated that with further refinements, the BETA circuit will become a useful treatment modality for unresectable liver tumours.
HP07 PROTEOMIC IDENTIFICATION OF SERUM MARKERS OF PANCREATIC ADENOCARCINOMA USING SELDI‐TOF MS
Authors: Baxter R. C. , Smith R. C. , Scarlett C. J. , Xue A. , Butturini G. , Scarpa A. 
Published: April 2007

More accurate biomarkers for pancreatic cancer (PC) would improve early detection and monitoring progress.Aim  To develop a biomarker panel for PC, using SELDI‐TOF technology and a bioinformatic approach and compare these markers to Ca19.9.Method  Serum samples from patients from the University of Sydney (UoS) were used to derive a diagnostic panel of proteins which was tested blindly on samples from the University of Verona (UoV). From UoS there were 38 PC, 54 disease controls (pancreatico‐biliary) (DC) and 68 healthy volunteers (HV) samples. From UoV there were 40 PC, 21 DC and 19 HV patients. The PC patients from UoV underwent a resection and were therefore in a relatively early stage. The biomarker panel was developed using a logistic regression/10 fold cross validation approach1. Ca 19.9 was also measured. Discriminatory power was assessed by ROC curve analysis.Results  The protein panel that best discriminated DC from PC included 7 protein peaks and HV from PC included 4 protein peaks. The discriminatory effect of the protein panel was similar to that of Ca19.9 but the combination of these panels and Ca19.9 was significantly improved P < 0.05, from 0.90 to 0.97 for comparison of PC with DC and from 0.90 to 0.99 for comparison of PC to HV. Results for samples from UoV were similar to those for UoS.Conclusion  A panel of serum proteins from PC patients in combination with Ca19.9, significantly improved the ability to identify PC from DC and HV samples. These results were confirmed when tested blindly on blood samples from Verona.
HP08 DOES NEO‐ADJUVANT CHEMOTHERAPY AFFECT THE ACCURACY OF FDG‐PET FOR PRE‐OPERATIVE PLANNING IN HEPATIC COLORECTAL METASTASES?
Authors: Adie S. , Yip C. , Chu F. , Morris D. L. 
Published: April 2007

Purpose  Pre‐op scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of neo‐adjuvant chemotherapy, which has marked biochemical and physical effects on the liver. FDG‐PET has clear applications for detecting extrahepatic disease. We investigated FDG‐PET as a pre‐op planning tool for detecting lesions in patients with and without neo‐adjuvant chemotherapy.Methodology  All patients who had resection of hepatic colorectal metastases between Jan 2004 and June 2006 were included. Patients were divided into those who received neo‐adjuvant chemotherapy and those who did not. The number of malignant hepatic lesions found on each scan was compared with those found on histopathology, intra‐operative examination and/or intra‐operative ultrasound. Accurate scans (scan lesions = true lesions), over‐estimations (scan lesions > true lesions) and under‐estimations (scan lesions < true lesions) were recorded.Results  21 patients had pre‐op FDG‐PET scans with neo‐adjuvant chemotherapy and 53 without. Accurate tests on a per‐patient basis were 6 (29%) for the chemotherapy group vs. 28 (53%) for the non‐chemotherapy group, p = 0.06. Notably, there were 11 (52%) under‐estimations in the chemotherapy group vs. 18 (34%) in the non‐chemotherapy group. There were 4 (19%) over‐estimations in the chemotherapy group vs. 7 (13%) in the non‐chemotherapy group.Conclusion  Pre‐op assessment with FDG‐PET is not useful for hepatic colorectal metastases, particularly when neo‐adjuvant chemotherapy is used. FDG‐PET is still useful however, for the assessment of extra‐hepatic disease.
ML02 INFORMED CONSENT FOR VASCULAR INTERVENTION IS IMPROVED BY DEPARTMENTAL AUDIT
Authors: Lewis D. R. , Carter K. , Frampton C. , Buckenham T. M. , Roake J. A. 
Published: April 2007

Aim  To re‐audit documentation of consent in patients undergoing vascular procedures.Method  A retrospective audit of elective vascular admissions from October 2005–2006 was undertaken to assess the impact of a previous audit (2005). Clinic letters, handwritten entries and consent forms were scrutinised and data collated on which doctors took consent, when consent was obtained, what details of the consent process were documented and whether additional information was made available.Results  99 notes were reviewed. For patients undergoing vascular surgery the consent form was signed by a consultant in 16 (32%) cases compared to 2 (4%) in the previous audit (p < 0.013). Significantly more vascular radiological consent forms were signed by a consultant (43) compared with surgical consent forms (16) (p < 0.001). Documentation that the risks of surgery had been discussed with the patient was present in 31 (62%) surgical notes. For radiological consent documentation, 34 (69.4%) patient notes recorded procedural risk. 22 (44.9%) of the vascular radiological patients had such risks documented in their outpatient notes by a vascular surgeon compared with 1 (2%) (p < 0.001) in the previous audit. Additional written information was given to 7 (14%) of the vascular surgical patients which was similar to the previous audit.Conclusions  Significant improvements have been made since the previous audit with more surgical consultants signing the consent forms and increased documentation of the nature of radiological procedures and risks discussed in outpatient clinics. From the current audit provision of additional written information (patient information sheets) was an area identified for future improvement.
ML05 WADDELL AND THE DECEIVING PATIENT – IS IT ALL INTENTIONAL?
Authors: Macleod A. D. 
Published: April 2007

The intensity of pain perceived following physiological insult is unique to that individual. Pain, by IASP definition, is a subjective and psychological symptom. Circumstances, personality and psychiatric illness may amplify (and less commonly mute) volunteered pain scores. Most pain is organically initiated and then psychologically contaminated. The psychological and psychiatric factors influencing pain scores will be considered.Patients with a propensity to somatise may elaborate and/or maintain ‘organic’ pain. This occurs ‘unconsciously’ (without awareness). This process deceives the patient (and often also the doctor). Intentional amplification of pain and the construction of pain behaviours for care‐eliciting purpose (factitious disorder) or personal gain (malingering) deceives others. Though there are clinical clues to feigned pains able to be obtained from the history and signs such as those proposed by Waddell, it is notoriously difficult to differentiate partial malingering, conversion or somatoform pain and the pain signature of the particular patient. If the intent of symptom formation and its continuance is psychological, medicine has a diagnostic role. If the intent is for personal greed or is criminal, the diagnosis rests upon legal issues.
ML08 CONDUCTING A REVIEW – THE IMPORTANCE OF PROCESS
Authors: Merry A. F. 
Published: April 2007

Reviews of practice tend to arise out of conflict between the person reviewed and the organisation requesting the review, usually after a failure of the two parties to resolve their differences at a lower level. It follows that legal challenges are likely, and this has been borne out by experience. Such challenges will generally be based on alleged failures in process. Furthermore, being reviewed is exceptionally stressful for any doctor and creates serious risks to his or her health and reputation. It is essential that these risks are minimized and that all parties emerge from the review believing that the process has been impartial, professional, confidential and fair.The key is to engage a senior lawyer with appropriate experience and expressly charge him or her (in writing) with the responsibility for process. This lawyer must be independent (the reviewing organisation’s own lawyers are not appropriate for this position), directly accountable to the chair of the review panel, and have unrestricted time for this task. He or she should be present at all meetings between the panel and the reviewed doctor and should revise all documents produced by the panel. The panel chair should assign the primary responsibility for reviewing the professional competence of the doctor to other panel members and should focus instead on ‘chairing’, on process, and on the wider (or ‘big picture’) issues which surround the review. Previous experience in reviews is essential for this role.
NS01 IS THERE A RESURGENCE OF CEREBRAL REVASCULARIZATION?
Authors: Laidlaw J. D. 
Published: April 2007

Since the publication in 1985 of the EC‐IC bypass study group, which demonstrated failure of EC‐IC bypass surgery to reduce stroke rate, there has been a dramatic reduction in the number of EC/IC bypass surgeries performed globally.However there have been ongoing concerns amongst neurosurgeons that the EC‐IC bypass operation still has a role, at least in selected groups of patients. These groups include, patients with Moya Moya disease, those requiring arterial sacrifice (particularly when trial occlusion demonstrates symptomatic cerebral ischaemia), and in certain patients with cerebral ischaemia in whom medical management has failed and there is a demonstrable reversible ischaemic deficit.Over the past decade there has been de‐skilling of the neurosurgical community in cerebrovascular procedures. Even those neurosurgeons who have maintained a high cerebrovascular case‐load rarely perform EC‐IC bypass surgeries. The technical demands of the procedure are such that it is difficult to maintain skill proficiency with a low case‐load.Nevertheless a few cerebrovascular surgeons at large institutions have recently noted an increase in referral of patients requiring EC‐IC bypass. Current multicentre studies are underway to re‐evaluate its role. It would seem likely that a modest increase in the demand for this surgery will occur.
NS12 THE MANAGEMENT OF SPASTICITY IN THE SPINAL INJURED PATIENT
Authors: Acland R. H. 
Published: April 2007

Spasticity is one of the hallmarks of the upper motor neurone syndrome which occurs following injury to the spinal cord anywhere above the level of the conus medullaris (approx L1). Early effective management of spasticity can prevent a multitude of complications. Persistent spasticity can result in contractures which significantly impair functional independence. There is a long history of the use of various surgical interventions for this complication.Physical therapy is pivotal in the overall management. A variety of pharmacological approaches are commonly used, however efficacy has to be balanced against adverse effects. The botulinum industry has limited benefit but can be useful in focal spasticity.In this presentation I will discuss the use of baclofen delivered via intrathecal catheters connected to sophisticated implanted pumps. In Christchurch we have had a multidisciplinary team providing this service for New Zealand. I will provide the results of our eight years experience in the use of intrathecal baclofen therapy (ITB). Assessment, baclofen pharmacology, surgical technique, efficacy, complications and costs will be discussed. The future challenges will also be highlighted.
NS13P A PROSPECTIVE COMPARISON OF TWO CERVICAL INTERBODY FUSION CAGES
Authors: Hansen M. A. , Mungovan S. , Ho D. , Kam A. 
Published: April 2007

Purpose  For some time the surgical management of chronic back pain has utilised interbody lumbar cages. Recently interbody cages for use in the cervical spine have been produced. Cervical cages provide initial stability during the fusion process. There is little literature comparing the performance of interbody cage systems due to their relative recent introduction.Methodology  Patients with symptomatic cervical degeneration or traumatic lesions were treated with the dynamic ABC 2 Aesculap anterior cervical plating system and either the B‐Braun Samarys or Zimmer cage systems. A single surgeon conducted all surgery. Pre‐ and post‐operative radiological examinations were compared. Changes in disc height at affected and adjacent levels, lordosis and evidence of fusion were recorded. Patient outcome was measured with questionnaires. The modified Oswestry neck pain disability and Copenhagen neck disability scale scores were utilised to allow comparison between patients.Results  A total of 43 patients were involved in the study (30 with the Zimmer cage system and 13 with the Samarys cage). Patient follow‐up has been up to 12 months. Improvement in disability scores was shown in 90% of patients. Follow up imaging did not demonstrate subsidence of the cage or adjacent instability in either group. There was no statistical difference in complication rate between the two groups.Discussion  Initial stability was provided by both interbody cervical spine cage system. Rates of fusion and symptomatic relief compared favourably to fusion involving autogenous bone graft without associated morbidity. Longer follow up is necessary to determine whether there is evidence of adjacent level instability or vertebral end‐plate subsidence.
NS14P PRIMARY FALCINE CHONDROSARCOMA
Authors: Kathiravel Y. , Finnis N. D. M. 
Published: April 2007

Primary intracranial chondrosarcomas account for under 0.16% of intracranial neoplasms and have been predominantly located in the skull base (1).Seventy five percent of intracranial chondrosarcomas originate from the skull base but they can arise from the meninges along the falx, tentorium and convexity (2).An intracranial classic chondrosarcoma arising from the falx is extremely rare and to date there is only a limited number of cases described in the literature (3).Falcine or parasagittal chondrosarcomas reported in the literature tend to be of a mesenchymal type.We present a case of a classic falcine chondrosarcoma in a 32 year old woman.Due to its rarity, there is little data on the management of these tumours.We review the diagnostic and management options pertaining to this tumour.