bluuebunny/crossref_metadata_2025_split huggingface dataset:
CR22P PERINEAL FLAP RECONSTRUCTION FOLLOWING EXTENDED RESECTION FOR PELVIC MALIGNANCY
Authors: Yeo A. W. , Heriot A. G. , McCombe D. B. , Morrison W. , Mackay J. 
Published: April 2007

Purpose  Extended resection for colorectal pelvic malignancy has shown good outcome but may involve extensive perineal resection necessitating plastic surgical reconstruction. The aim was to assess the indications, techniques, morbidity, and outcome of perineal flap reconstruction for extended pelvic resection.Methods  Patients requiring perineal flap reconstruction following colorectal resection at a tertiary centre from 1994 to 2006 were identified from a prospective colorectal database. Details of the indication, procedure, morbidity, and outcome were obtained from the database and retrospective chart review.Results  21 patients (11 male, 10 female), median age 59 years (range 26–80) underwent perineal flap reconstruction. Indications for resection were advanced primary colorectal cancer (7), recurrent rectal carcinoma (8), recurrent anal carcinoma (3), and other pelvic malignancy (3). 18/21 patients had neoadjuvant radiotherapy. Reconstruction was by pedicled flap in 14 patients (5 gracilis flap, 7 vertical rectus abdominal muscle flap; 1 gluteal rotation flap) and latissimus dorsi free flap with microvascular anastomosis in 7 patients. Eighteen patients had immediate reconstruction and three were delayed. Five patients underwent vaginal reconstruction following posterior vaginectomy. There were four major flap complications (19%) requiring five unplanned reoperations. There were 2 minor complications (10%) requiring 1 unplanned reoperation. There were no donor site or longterm flap complications.Conclusion  Perineal flap reconstruction by both pedicled and free flaps may be achieved with low morbidity following extended pelvic resection.
CR04 SIX YEAR, PROSPECTIVE ANALYSIS OF RECTAL BLEEDING CLINICS AT THE QUEEN ELIZABETH HOSPITAL, ADELAIDE, SOUTH AUSTRALIA
Authors: Lee J. S. J. , Rieger N. , Stephens J. , Rodda D. , Hewett P. , Lawrence M. 
Published: April 2007

Background  One stop rectal bleeding clinics are designed to diagnose and treat colorectal diseases which present with rectal bleeding. The Queen Elizabeth Hospital rectal bleeding clinic is an open access clinic and is unique in South Australia. It offers flexible sigmoidoscopy and facilities for treating common anorectal conditions.Methods  All patients presenting to the rectal bleeding clinic were prospectively recorded into a database. Data is collected on the presentation, past medical history, diagnosis, treatment and intended follow‐up.Results  A total of 1539 cases were seen in the clinic between March 2000 and February 2006. Flexible sigmoidoscopy was performed in 1145 cases (75.03%). Banding or injection of haemorrhoids was performed in 383 cases. A total of 590 patients were referred for colonoscopy and of these 27 were diagnosed with colorectal adenocarcinoma or squamous cell cancer of the anus. The majority of these patients were over 50 years old (26 of 27; 96.30%) and had associated symptoms, such as weight loss or altered bowel habit, with their rectal bleeding (23 of 27; 85.19%).Conclusions  Rectal bleeding clinics can facilitate early diagnosis of colorectal malignancy and can also provide a ‘one stop shop’ for treating benign anorectal conditions.
CR06 DEFICIENCIES IN PATHOLOGICAL REPORTING OF COLORECTAL CANCER IN VICTORIA
Authors: Robinson D. R. , Winn R. D. , Bell S. W. 
Published: April 2007

Background  Colorectal cancer (CRC) pathological reporting deficiencies have been shown to be common with deviations from the minimum data set. Both information from the surgeon and pathologist is necessary for a complete report. These deficiencies have been shown to be correctable with the use of proformas. We performed an audit on a random sample of CRC pathological reports from the first six months of 2004, in Victoria Australia.Methods  A random sample of pathological reports for CRC were obtained from the Victorian cancer council. 120 of these reports were reviewed by a team of surgical and pathological trainees. Presence or absence of the NHMRC minimum data set for CRC reporting was recorded.Results  There were large deviations from the minimal dataset. Most notable was the absence of the information on the apical node, the presence of metastasis and vascular and perineural invasion.Conclusions  The opportunity existed for considerable improvement in the pathological reporting of CRC in Victoria in 2004.
CR07 CONTINUOUS WOUND INFUSION OF LOCAL ANAESTHETIC IN THE CONTROL OF PAIN FOLLOWING ELECTIVE ABDOMINAL COLORECTAL SURGERY
Authors: Polglase A. L. , McMurrick P. J. , Simpson P. J. B. , Chee J. , Ooi C. W. , Kingsland S. R. 
Published: April 2007

Purpose  Local anaesthetic wound infusions have been investigated in recent years as a potential alternative to standard analgesic regimens following major surgery. This study investigates the efficacy of a continuous wound infusion of ropivacaine in conjunction with best practice postoperative analgesia following midline laparotomy for colorectal surgery.Methodology  310 patients presenting for major colorectal surgery were included in this prospective, randomised, double‐blind, placebo controlled trial. Patients were allocated to receive either ropivacaine 0.54% or normal saline via a dual catheter Painbuster Soaker(tm) continuous infusion device for 72 hours postoperatively.Results  The continuous wound infusion of ropivacaine following abdominal colorectal surgery conveys minimal benefit when compared with saline wound infusion. No statistically significant difference could be shown for, pain at rest, morphine usage, length of stay, mobility, nausea or return of bowel function.Conclusion  Management of pain following elective abdominal colorectal surgery is best achieved through adopting a multimodal approach to analgesia. Delivery of ropivacaine to midline laparotomy wounds via a Painbuster Soakerä device is safe but has no clinical application following major abdominal colorectal surgery.
AL05 OF STRINGS AND SPLINTS AND WARS AND WOUNDS
Authors: Jeffery A. K. 
Published: April 2007

Robert Hamilton Russell (1860–1933), a Melbourne surgeon of international repute, played a pivotal role in the formation of the College. In 1925 a letter signed by G.A.Syme H.B.Devine and Russell was sent to senior surgeons in Australia and NewZealand suggesting the establishment of a body to improve surgical standards, a proposal first put by Louis Barnett in 1920.Born in Kent with medical training at King’s College, Hamilton Russell was House Surgeon to Lister and profoundly influenced by Lister’s mentoring. Russell emigrated to Melbourne in 1890 and with appointments at the (Royal) Children’s Hospital and the Alfred, developed wide surgical interests including fracture management.At the start of World War I, Hamilton Russell was in England and joined the Australian Voluntary Hospital in France. On returning to Melbourne in 1915 he presented a paper on the treatment of war wounds and in 1916 a paper on fractures included his new method of continuous traction for femoral shaft fracture. At this time the proper management of war wounds and fractures was being vigorously debated.It was not until the Spanish Civil War, three years after Hamilton Russell’s death, that significant advances were made in the management of war injuries. In Barcelona, Joseph Trueta successfully combined the principles of triage, blood transfusion, early surgery, wound excision and plaster immobilisation. In 1939 Trueta escaped to Britain and with the aid of influential colleagues his techniques with some modification were adopted during the 1939–45 conflict and form the basis of war wound management today.
ES01 THE IMPACT OF SYNOPTIC CYTOLOGY REPORTING ON THYROIDECTOMY RATE IN A SINGLE INSTITUITION
Authors: Tsan C. J. L. , Serpell J. W. 
Published: April 2007

Background  Fine needle aspiration cytology (FNAC) is integral to diagnosis and management of patients with thyroid nodules. We introduced synoptic cytology reporting for thyroid nodules in 2004. The aim of the study was to examine the impact of synoptic cytology reporting.Methods  A comparative study of two 2‐year periods (1/8/2002–1/8/2004 and 2/8/2004–2/8/2006) prior and post introduction of synoptic reporting was conducted from a prospectively collected database of patients presented with thyroid nodules. All data were analysed using Microsoft excel and statistics calculated with likehood ratio and chi square tests.Results  There were a total of 660 patients. Of these 376 were operated and 284 non‐operated. The female to male ratio was 1 : 7. Comparing the 2 periods, the overall FNAC sensitivities were 60% vs 79.1%, specificities were 83.7% vs 79.4%, accuracy 76% vs 79.3%, false positive 16.3% vs 20.6% and false negative of 40% vs 20.9%. The non diagnostic rates were 7.4% vs 3.15%. FNAC prompted surgery in 66.7% vs 100% in carcinoma and 56.4% vs 73.6% in adenoma. A benign FNAC prompted surgery in 15% VS 19.8% of cases. The total rate of surgery has decreased by 2.7%.Conclusions  Synoptic cytology reporting has resulted in an overall improvement in all measures of the tests. The rate of surgery has decreased by 2.7%. Synoptic cytology reporting is therefore recommended for all endocrine surgical units.
ES11 INCREASING INCIDENCE OF THYROID CANCER IN RETROSTERNAL GOITRE
Authors: Grodski S. , Brown T. , Gill A. , Sywak M. , Sidhu S. , Delbridge L. 
Published: April 2007

There has been a documented worldwide increase in the incidence of thyroid cancer attributed to increased surveillance. The aim of this study is to determine wether thyroid cancer incidence is also increasing in the group of patients with retrosternal goitre, who are not typically the subject of ultrasound surveillance.This is a retrospective clinical review of all patients undergoing thyroidectomy for retrosternal goitre over a 40 year period. Histology of all recorded thyroid cancers were reviewed by a single pathologist and reclassified according to current WHO criteria. Statistical analysis was performed using the chi‐square test.Between 1966 and 2005, 2026 patients were operated on for retrosternal goitre on a background of 13,793 thyroid procedures. While absolute numbers of retrosternal procedures remained stable, the rate as a percentage of all thyroid surgery dropped from 21% to 12% (p < 0.05). At the same time the percentage of retrosternal goitres with carcinoma increased from 3.6% to 8% (p < 0.05). However, if microcarcinomas (<10 mm) are excluded then the increase is only 2.9% to 4.3% (p = NS).Routine ultrasound surveillance is not relevant for patients with retrosternal goitre and hence the changes in thyroid cancer incidence in this study can not be attributed to this change in practice. This study has once again demonstrated an increasing incidence of thyroid cancer, however, there is no increase in the incidence of clinically significant cancers.This study removes surveillance as a confounding factor and has shown that the increasing incidence of thyroid cancer is due to increased reporting of microcarcinomas and that there is no increase in clinically significant cancers.
ES12 CAN GIANT PARATHYROID ADENOMAS BE SAFELY REMOVED BY MINIMALLY INVASIVE PARATHYROIDECTOMY?
Authors: Meyer‐Rochow G. Y. , Sidhu S. B. , Delbridge L. W. , Grodski S. , Sywak M. S. 
Published: April 2007

Purpose  Minimally invasive parathyroidectomy (MIP) has become the procedure of choice for the surgical management of a parathyroid adenoma (PA) which localizes on preoperative imaging. The removal of giant PA (weighing greater than two grams) by the minimally invasive technique has not previously been described. Our aim was to determine the safety and efficacy of the removal of giant parathyroid adenomas at MIP.Methodology  This is a retrospective case control study. The study group comprise all patients undergoing MIP where the gland weight was >2.0 gm in the period 1998 to 2006. The control group comprised all other patients undergoing MIP (gland weight <2.0 gm over the same period.) MIP was performed using the lateral mini‐incision technique.Results  There were 52 giant PA (M : F – 16 : 36, mean age 61.9) comprising 3% of all cases, and 785 control patients (M : F – 160 : 625, mean age 58.9). The mean weight of the giant PA was 3.64 gm (range 2.0 to 10.8 gm). The giant PA were successfully removed in 49/52 cases with 3 conversions (5.7%), whereas there were 40/785 conversions (5.0%) in the control group (p = 0.83). There was 1/52 (1.9%) permanent recurrent laryngeal nerve injury in the study group and 2/785 (0.3%) nerve palsies in the control group (p = 0.51). One patient (1.9%) in the giant PA group had persistent hyperparathyroidism, whereas there were 21 (2.7%) patients in the small adenoma group requiring re‐exploration for persistent hyperparathyroidism. There were 2/52 (3.8%) carcinomas in the giant PA group compared to 2/785 (0.25%) in the control group.Conclusion  Excision of giant PA using a minimally invasive technique can be performed with the same safety, efficacy and outcomes as for smaller adenomas.
ES13 PHEOCHROMOCYTOMA – AN ANALYSIS OF 123 PATIENTS
Authors: Selvan C. K. , Nair A. , Paul M. J. , Abraham D. T. , Thomas N. , Seshadri M. S. 
Published: April 2007

Background  Pheochromocytomas are diagnosed in <1% of patient evaluated for hypertension.Methodology  A retrospective analysis of case records of those patients with histopathologically confirmed pheochromocytoma in our hospital from 1976–2006 [30 YEARS] was conducted.Result  A total of 123 patients were diagnosed during this period. The median age at presentation was 31 years (range 9–71) with a male to female sex distribution of 75% and 36%. 80% were hypertensive at the time of diagnosis. Headache(84%), palpitations(64%) and sweating(60%) are the most common presenting complaints.Tachycardia [>100 per minute]were seen in 31%. Hypertensive changes in eyes were seen in 87%. In ECG, QTc prolongation in 26%, left ventricular hypertrophy in 30%. Diabetes mellitus/IGT was seen in 35%. Elevated urinary VMA (24 hrs) was seen in 93% when done on 3 consecutive days.MIBG was positive in 85%. Malignant pheochromocytoma was diagnosed by tumour invasion/metastasis seen 10.44%. Extra adrenal pheochromocytoma 18%, followed by bilateral pheochromocytoma in 11%. Hereditary pheochromocytoma in 13% which include 5 with Von Hippel Lindau and 6 with MEN.A median follow‐up was 12 months (range 1–204) in which persistent hypertension was seen in 16%. Cholelithiasis in 7%.Conclusion  In our case series the mean age (31 yrs) of presentation seems to be younger compared to other case series. 16% of our patients were asymptomatic at the time of presentation. Urinary VMA was elevated in 93% of patients when done in 3 consecutive samples. Extra adrenal pheo was common in our patients (18%). MIBG was false negative in 15% of those patients with pheochromocytoma.
ES14P THYROID CANCERS IN CHILDHOOD – A PROSPECTIVE REVIEW OF THE MALAYSIAN POPULATION
Authors: Harjit K. , Hisham A. N. 
Published: April 2007

Objective  The aim of this study was to review the incidence and pattern of childhood thyroid cancers at our center. We also evaluate the possible risk factors and the outcome of treatment.Methodology  Prospective review of all childhood thyroid cancers operated at Putrajaya Hospital from Jan 2002 to Dec 2006. All data was prospectively reviewed and analyzed.Results  A total number of 20 patients (58.8% of the total number of paediatric goiters) were accrued in this study. The Male : Female ratio was 1 : 4. The mean age was 16.1 (ranged 6–21 years). All patients were euthyroid on presentation. 13 presented with a solitary nodule, 6 with a multinodular disease, 1 thyroglossal cyst and 6 with associated palpable lymph nodes. All were differentiated thyroid cancers; 18 were papillary thyroid cancer (14.1% of total adult population, 18/127) and 2 were follicular (10.5%, 2/17).Total thyroidectomy was done in 12 patients, completion surgery in 8. 9 patients required additional modified radical neck dissection. There was no history of previous irradiation to neck. All patients received radioiodine ablation (RAI) postoperatively. Average weight of gland was 3.2 g and the average size was 3.5 cm. 2(10%) patients developed nodal recurrence. There was no morbidity or mortality in this series. 1 patient had recurrent laryngeal nerve paresis preoperatively. All 20 patients are still alive on a mean follow up of 22 months.Conclusions  Our study showed that the incidence of malignancy in childhood goiters is significantly high and best option of treatment is total thyroidectomy with or without neck dissection.
ES16P HYPOTHYROIDISM FOLLOWING HEMITHYROIDECTOMY
Authors: Su S. Y. , Serpell J. 
Published: April 2007

Background  The incidence and risk factors for hypothyroidism in patients undergoing partial thyroid surgery remain unclear. Hypothyroidism is an under‐appreciated sequel of hemithyroidectomy. The early recognition of post‐operative hypothyroidism will alleviate symptoms and may prevent recurrent thyroid disease.Aim  To investigate the incidence, time to onset and risk factors for the development of hypothyroidism following hemithyroidectomy.Methods  Patients undergoing hemithyroidectomy from August 1992 to June 2006 by a single surgeon were identified from an existing, prospectively collected thyroid database. Records were reviewed retrospectively. Patients were analysed for age, sex, family history of thyroid disease, thyroid antibody levels, pre and post‐operative TSH, histological diagnosis, the presence of concurrent thyroiditis, and the lag time to diagnosis of hypothyroidism. Chi‐squared or Fisher’s exact test were performed.Results  Hypothyroidism was diagnosed in 36 (12%) of 300 patients. The mean time to diagnosis was 7.54 months. The mean thyroxine dose was 77.38. Patients with post‐operative hypothyroidism had a higher incidence of elevated pre‐operative TSH levels (8.3% versus 0; P < 0.01), thyroiditis on histology (50% versus 12.2%; P < 0.01) and elevated thyroid antibodies levels (48.1% versus 11.3%; P < 0.01). Age, gender, family history of thyroid disease, and thyroid pathology were not significant risk factors for hypothyroidism.Conclusion  Given an incidence of 12%, all patients should have post‐operative thyroid function assessment. Elevated preoperative TSH and thyroid antibody levels, and the presence of thyroiditis on histology are indications for close monitoring.
ES03 THE DELPHIC LYMPH NODE AND THYROID CANCER
Authors: Isaacs J. D. , Ihre‐Lundgren C. , Sidhu S. , Sywak M. , Edhouse P. , Delbridge L. 
Published: April 2007

Background  Named after the oracle of Delphi, the Delphic (or prelaryngeal) lymph node has long been regarded as a predictor of malignancy in thyroid cancer. It also has a notorious reputation for being a marker of advanced nodal disease. There is no current medical literature to support or refute these claims. The aim of this study was to determine the true significance of Delphic lymph node involvement in thyroid cancer.Methods  1,000 consecutive patients undergoing total thyroidectomy formed the study population. All information was obtained from a prospectively maintained database as well as from review of the histopathology records.Results  227 of 1,000 (22.7%) had a final diagnosis of thyroid cancer. In 63 of 227 (27.8%), the final diagnosis of cancer was unsuspected. The Delphic lymph node was removed in 112 of 227 patients, with 22 of 112 cancerous. Thus, 19.6% of patients had involvement of the Delphic lymph node when it was removed. Delphic node involvement was associated with significantly greater nodal disease (10.1 vs 1.4 nodes; p < 0.05). No patient in either group had Delphic node involvement diagnosed on clinical grounds preoperatively.Conclusion  Despite its reputation, the Delphic lymph node is not itself an independent predictor of the presence of thyroid cancer. It is however a useful marker of extensive local nodal disease. Identifying intra‐operatively whether the Delphic node is involved may assist in planning the extent of neck dissection during total thyroidectomy.
ES04 TOTAL THYROIDECTOMY – DOES UNDERLYING PATHOLOGY EFFECT PARATHYROID AUTOTRANSPLANTATION AND RELATED COMPLICATIONS?
Authors: Ebrahimi H. , Lundgren C. I. , Sidhu S. B. , Sywak M. S. , Edhouse P. , Delbridge L. W. 
Published: April 2007

Background  Total thyroidectomy (TT) is increasingly being accepted as the preferred surgical option for the treatment of a majority of benign and malignant thyroid conditions. Parathyroid autotransplantation is an accepted technique for retaining parathyroid function following TT. The present study aims to determine whether the underlying thyroid pathology has any effect on the number of parathyroid glands autotransplanted and subsequent complications.Methods  A retrospective study of all TT cases performed by this unit in 2004–2005 was performed. The underlying pathology, number of parathyroid glands autotransplanted and incidence of temporary hypocalcaemia and permanent hypoparathyroidism were recorded.Results  A total of 681 TT were analysed. Of these, 80 (11.7%) were for Graves’ disease and 601 (88.3%) were for other pathologies. For the Graves’ disease cases, 49 (61.3%) required 1 or less parathyroid glands to be autotransplanted and 31 (38.8%) required 2 or more. This is compared to 443 (73.7%) and 156 (26.0%) for non‐Graves’ disease cases (p = 0.023). There was also a significant difference (p = 0.025) in the incidence of temporary hypocalcaemia between Graves’, 10 (12.5%) and non‐Graves’ cases, 33 (5.5%). The incidence of permanent hypoparathyroidism was 1 (1.3%) and 5 (0.8%) for Graves’ and non‐Graves’ cases respectively (p = 0.529).Conclusion  Total thyroidectomy for Graves’ disease does require the autotransplantation of significantly more parathyroid glands and increases the incidence of temporary hypocalcaemia post TT. It does not however significantly increase the incidence of permanent hypoparathyroidism.
ES07 MICROARRAY GENE EXPRESSION ANALYSIS OF HUMAN ADRENOCORTICAL TUMOURS
Authors: Soon P. S. H. , Sidhu S. B. , Benn D. E. , Gill A. , Robinson B. G. , McDonald K. L. 
Published: April 2007

Introduction  Adrenal tumours are common, occurring in 7% of patients over the age of 50. Adrenocortical carcinomas, however, are rare, with an incidence of two per million population per year. The management of adrenocortical tumours is complex, compounded by the difficulty in discriminating benign from malignant tumours using conventional histology. A molecular marker which could reliably distinguish between the two groups would be valuable in patient management.Objectives  The aim of this study was to identify molecular markers which will discriminate between adrenocortical carcinomas and adenomas using microarray gene expression analysis.Methods  This study used RNA from 6 normal adrenal cortices, 16 adrenocortical adenomas and 12 carcinomas. Only samples with an RNA integrity number of 7.5 or greater were used. The samples were hybridised to Affymetrix HGU133plus2.0 genechips. Data analysis was performed with Partek and affylmgui softwares.Results  Using a cutoff of B > 2 and M > 2 or <−2, 217 genes were found to be significantly differentially expressed between adrenocortical adenomas and carcinomas. Of these genes, 120 were unpregulated while 97 were downregulated. Seven of these genes have been selected for validation studies with real time reverse transcription polymerase chain reaction.Conclusion  In this study, we found 217 genes which were significantly differentially expressed between adrenocortical adenomas and carcinomas. With validation and further studies, these genes will provide further insight into the pathogenesis of adrenocortical tumours as well as possibly proving to be reliable discriminators between adrenocortical adenomas and carcinomas.