bluuebunny/crossref_metadata_2025_split huggingface dataset:
PANCREATITIS AND PRIMARY HYPERPARATHYROIDISM: FORTY CASES
Authors: Carnaille B. , Oudar C. , Pattou F. , Combemale F. , Rocha J. , Proye C. 
Published: January 2008

Background: Pancreatitis is associated with primary hyperparathyroidism (PHPT) in 1.5–7% of cases. The relationship of cause and effect between the two diseases has been debated. Methods: To evaluate this relationship, the clinical, biochemical and pathological data on 1435 patients operated on for hyperparathyroidism (HPT) over the past 30 years were retrospectively reviewed. A total of 1224 of these patients had biologically proven and cured PHPT and 211 patients had renal HPT (RHPT). The diagnosis of pancreatitis (PTS) was based on a high serum amylase level and/or abnormalities on ultrasound or computed tomography (CT) scan explorations. Only patients without biliary stones were included in the PTS group associated with HPT. Results: A total of 3.2% (n= 40) of patients with PHPT had PTS, which was acute in 18 cases, subacute in 8 cases and chronic in 14 cases. This rate of PTS is higher than in a random hospital population. Surgical cure of HPT was followed by the spontaneous healing of 17/18 acute PTS, whereas six of the 22 patients with subacute or chronic PTS developed complications due to the evolution of their disease (diabetes, pancreatic duct stenosis treated by surgery). A single diseased gland was found in 27 patients with PTS, which is in favour of primary parathyroid disease, being responsible for, and not a consequence of, PTS. Only the serum calcium (13.0 vs 12.1 g/dL) level was significantly increased in PHPT patients with PTS, when compared to those without PTS. The calcium level is probably of major importance in the development of PTS, which was never encountered in 211 patients with RHPT, who had low calcium and high PTH levels. Conclusions: The data suggest that (i) the PTS‐PHPT association is not incidental; (ii) PTS is the consequence and not the cause of PHPT; (iii) hypercalcaemia seems to be a major factor in the development of PTS in PHPT patients; and (iv) cure of PHPT leads to the healing of acute PTS, whereas it does not affect the evolution of subacute and chronic PTS.
EARLY FEEDING AFTER ELECTIVE OPEN COLORECTAL RESECTIONS: A PROSPECTIVE RANDOMIZED TRIAL
Authors: Stewart B. T. , Woods R. J. , Collopy B. T. , Fink R. J. , Mackay J. R. , Keck J. O. 
Published: January 2008

Background: A period of starvation after colorectal resections to allow for resolution of the clinical evidence of ileus has been an unchallenged surgical doctrine until recent times. A prospective randomized trial comparing early feeding to traditional management in patients undergoing open elective colorectal resections is reported. Methods: Patients undergoing elective intraperitoneal colorectal resections without stoma formation were randomized to either an early feeding or control group. The early feeding group were allowed free fluids from 4 h postoperatively progressing to a solid diet from the first postoperative day as they tolerated it. The control group remained nil orally until passage of flatus or bowel motion and were then commenced on fluids progressing to solids over 24–48 h. Results: There were 40 patients in each group well matched for age, sex, type and duration of operation, method of analgesia and mobilization. Thirty‐two patients (80%) in the early feeding group tolerated a diet within 48 h. There was no significant difference in the rate of vomiting, nasogastric reinsertion or complications. The early feeding group tolerated a diet, passed flatus, used their bowels, and were discharged from hospital significantly earlier than the control group. Conclusion: Early feeding after elective open colorectal resections is successfully tolerated by the majority of patients, leading to earlier resolution of ileus and hospital discharge.
UNPLANNED RETURN TO THE OPERATING ROOM
Authors: Isbister William H. 
Published: January 2008

Background: Unplanned return to the operating room (OR) has been suggested as one of the indicators that could be used to assess the quality of surgery in a hospital setting. The present study was undertaken in order to try to identify those factors that were important in determining the need for the return to the OR in patients undergoing a series of colorectal surgical procedures. Methods: All patients who returned to the OR following an index colorectal procedure during a 15‐year period on a colorectal service, were identified from the unit's database. The site of original disease, presentation, type of surgery performed, reason for re‐operation and post‐surgical morbidity and mortality were examined. Results: Overall there were 2011 colorectal surgical admissions, and of these 19 males (61.2 years) and 18 females (67.4 years) underwent an unplanned return to the OR. In 34 patients the index operation was performed by a consultant surgeon. A total of 46% of index operations were performed in an emergency setting. The majority of patients had colorectal cancer. Most lesions were situated in the sigmoid colon or rectum. Postoperative adhesive obstruction was the commonest reason for return to the OR. No patient re‐obstructed following re‐operation. Overall eight wounds dehisced and five patients suffered anastomotic leakage. Intra‐abdominal sepsis was found in 12 patients. Twenty‐one patients developed urinary tract infections. Twenty‐eight patients were discharged well, two patients were discharged dying with advanced malignancy and there were seven postoperative deaths (18.9%). Conclusions: Unplanned return to the OR is a function of both the patient's presenting problem and the surgical skill and judgement of the surgeon. It is thus in part determined by the patient casemix in a unit, service or institution.
ASSOCIATION OF OBESITY, GENDER, AGE AND OCCUPATION WITH CARPAL TUNNEL SYNDROME
Authors: Lam Nicholas , Thurston Alan 
Published: January 2008

Background: The present study determines the association of obesity, gender, age and occupation in patients with carpal tunnel syndrome (CTS) in a New Zealand population. Methods: Analysis of questionnaires and clinical review of patients who had undergone surgical decompression of the median nerve in the carpal tunnel. Results: The age and gender distribution of 655 hands (512 patients) that had undergone carpal tunnel release (CTR) were compared with the age and gender distribution of the New Zealand population. The results indicate that the 3‐year‐period prevalence of CTS in females is more than double that in males. Proportionally there were more patients over age 55 than in the general population. The findings also indicate that, proportionally, six times the number of females who worked in moderate manual work underwent CTR compared with the general female population and proportionally twice the number of males who worked in heavy office/clerical work underwent CTR compared with the general male population. It was also found that CTR patients are twice as likely to be overweight (body mass index [BMI] > 25) than the general population and female patients are twice as likely to be obese (BMI > 30) than the general population. Conclusions: Carpal tunnel syndrome is more than twice as common in females as it is in males, and patients aged more than 55 years are more likely to suffer from CTS. Females with CTS are more likely to work in moderate manual work and males with CTS are more likely to work in heavy office/clerical work. Obesity and CTS are related statistically.
THE MITROFANOFF PROCEDURE IN PAEDIATRIC URINARY TRACT RECONSTRUCTION
Authors: Ahmed Saeed , Sen Sudipta 
Published: January 2008

Methods: Between 1991 and 1996, 23 children underwent urinary tract reconstruction of varying complexity together with a continent diversion according to the Mitrofanoff principle. The appendix was used in 14 patients and the ureter in seven. Two patients had previously had an appendicectomy and the ureters were not suitable. One had a catheterizable channel made from an isolated segment of colon and the other had a detrusor tube constructed. Background: Urinary tract reconstruction is required in many congenital and some acquired urological conditions in childhood. The majority are managed by clean intermittent catheterization (CIC), for which purpose the appendix or other tubular structure may be used to provide a continent catheterizable abdominal stoma. Results: Twelve patients with an appendix conduit, six with a ureteric conduit, and one with a colonic tube are continent, although the latter has had some problems with stomal stenosis. All manage CIC with comfort, the older children doing the procedure themselves. One appendix conduit has stomal incontinence and another was inadvertently divided during renal transplantation. The detrusor tube strictured and was removed. Conclusions: A continent abdominal stoma using the Mitrofanoff principle gives reliable results in children and is well tolerated. It should be considered in the management of children undergoing urinary tract reconstruction when CIC is necessary. The appendix is eminently suitable for this purpose but the ureter provides a satisfactory alternative in selected cases. When neither is available, alternative techniques for constructing a catheterizable continent channel may be considered.
STAGING OF OESOPHAGEAL CARCINOMA BY ENDOSCOPIC ULTRASOUND: PRELIMINARY EXPERIENCE
Authors: Pham T. , Roach E. , Falk G. L. , Chu J. , Ngu M. C. , Jones D. B. 
Published: January 2008

Background: Endoscopic ultrasound (EUS) is a relatively recent imaging modality that is capable of visualizing oesophageal tissue layers and para‐oesophageal structures. Current pre‐operative staging of oesophageal cancer is less than satisfactory, and a modality which may improve pre‐operative staging, thus allowing a more rational approach to choice of treatment, may be a welcome addition to current techniques. The purpose of the present study was to evaluate the accuracy of EUS in the staging of oesophageal carcinoma in a consecutive cohort of patients. Methods: Forty‐three patients with oesophageal cancer were prospectively staged with EUS using the radial scanning Olympus EUM–3 echo‐endoscope. In the 28 patients who underwent surgery EUS staging was correlated with operative and histological findings to evaluate the EUS accuracy rate of assessing tumour depth (T stage), and the presence of nodal involvement (N stage) using internationally accepted TNM staging criteria. Results: Endoscopic ultrasound accuracy rates for overall T‐staging was 61% whereas that of N‐staging was 75%. The overall TNM pathological staging was 75% accurate by EUS. Conclusions: Compared to published literature figures for oesophageal staging by computed tomography scanning (39–54%) these results demonstrate that EUS has a reasonable accuracy rate for staging. Endoscopic ultrasound may prove to be a useful additional modality in the management of oesophageal cancer.
PAEDIATRIC SURGICAL TRAINING: A SYSTEM THAT WORKS
Authors: Merriman T. , Maoate K. , Clarnette T. , Hutson J. M. 
Published: January 2008

Background: Paediatric surgical trainees going through the system at the Royal Children's Hospital (RCH), Melbourne, have been impressed with the amount of time dedicated to postgraduate training compared with other institutions. They generally felt well prepared to sit for Fellowship examinations. We decided to look at the programme offered at the RCH and objectively assess the results. Method: A review was undertaken of the training system at the RCH. Opinions were sought from recent and current trainees and compared with trainees in other disciplines. Figures were obtained from the RACS Examinations Office with respect to pass rates at Fellowship examinations. Results: The training programme is outlined in some detail. A total of 79% of candidates passed their FRACS in paediatric surgery while at the RCH since 1985, compared with 52% from all other institutions. Conclusions: A successful training programme requires a commitment to educate one's junior colleagues. Busy consultants can contribute actively by offering to teach and by encouraging their trainees to attend rounds and tutorials. The rewards are better‐educated and well‐rounded surgeons as well as, hopefully, a higher pass‐rate at the Part 2 examination.
DIAGNOSTIC FAILURE IN COLONOSCOPIES FOR MALIGNANT DISEASE
Authors: Miller Brian J. , Cohen Jon R. , Theile David E. , Schache David J. , Ku Jack K. 
Published: January 2008

Background:While colonoscopy has become established as more accurate than double contrast barium enema for detecting colonic polyps and cancers, as well as offering the opportunity for therapy, there are occasional instances where colonoscopy is misleading. The present study is to determine what problems occur, with a view to finding a solution.Methods:The records of the Colorectal Project at the Princess Alexandra Hospital indicate retrospectively that 346 patients have been correctly diagnosed with cancer of the colon and rectum by colonoscopy in the 5 years up to October 1996. During the same time eight patients (2.3%) were recorded at the same hospital as being misdiagnosed by colonoscopy, the lesion being either missed completely or misplaced.Results:In five of these patients there was failure to recognize that the whole colon had not been examined endoscopically, thereby missing a more proximal lesion. In two patients the lesion was missed although the entire colon was examined. In one patient the lesion was discovered but inaccurately sited. Six of these mistakes would have been obviated by the routine use of fluoroscopy to confirm the totality of the colonoscopy and to site any lesions found. The other two cases occurred because of failure to remember that colonic examination during withdrawal should be performed meticulously back as far as the anal canal. Failure to diagnose a colon cancer on the initial colonoscopy led to an average delay of 6 months for definitive care.Conclusions:It is recommended that fluoroscopy be used routinely during colonoscopy to site accurately any lesions found, and to confirm the completeness of insertion if reliable landmarks, including terminal ileum, are not clearly identified.
RANDOMIZED CONTROLLED TRIAL COMPARING SAME‐DAY DISCHARGE WITH HOSPITAL STAY FOLLOWING HAEMORRHOIDECTOMY
Authors: Ho Y‐H. , Lee J. , Salleh I. , Leong A. , Eu K. W. , Seow‐Choen F. 
Published: January 2008

Background:A randomized controlled trial was conducted to compare traditional hospital stay haemorrhoidectomy (STAY) with same‐day discharge haemorrhoidectomy (DAY) with regard to costs, clinical outcome and patient satisfaction.Methods:A total of 54 consecutive patients were randomized to either STAY or DAY groups. A standardized excision of three piles was performed and the wounds were left open. The DAY patients went home on the same day but the STAY patients remained in hospital until their bowels had opened. A linear analogue pain score and patient satisfaction questionnaire were administered. During a mean follow‐up of 60.5 (standard error of mean =1.2) weeks, the complications and the total medical costs were recorded.Results:There were no differences in the age and sex distributions in both groups (STAY: 11 men, 16 women; mean age 40.6 (± 1.8) years; DAY: 10 men, 17 women; mean age 40.6 (± 1.9) years). Despite accounting for any readmissions, the DAY patients accumulated shorter total hospitalization stays (P < 0.001) and incurred less total medical costs (P= 0.04). The pain scores, analgesia requirements, postoperative complications, patient satisfaction and time taken off work were not different between the two groups. However, more patients in both groups preferred to stay after surgery if they should need another haemorrhoidectomy.Conclusions:Haemorrhoidectomy (with excision of three piles) can be safely performed as a day procedure, with reduced hospitalization and medical costs.
APPENDICITIS IN HIV‐POSITIVE PATIENTS
Authors: Bova R. , Meagher A. 
Published: January 2008

Background:The aim of the present study was to review the experience of appendicitis in human immunodeficiency virus (HIV)‐positive patients.Methods:A retrospective analysis of all HIV‐positive patients operated on for suspected acute appendicitis during a 10‐year period at St Vincent'Hospital was performed. These patients were compared to a group of 60 age‐ and sex‐matched patients with no HIV risk factors who were operated on during the same time period.Results:On presentation the clinical findings were similar in both groups, with two notable exceptions. No HIV‐positive patient had an elevated white cell count. The present study demonstrated a significant delay in presentation of the HIV‐positive group to the Emergency Department, possibly explaining the higher appendiceal perforation rate in this group. There were no cases of HIV‐related diseases mimicking acute appendicitis. There was no mortality, and morbidity was higher in the seropositive group.Conclusions:HIV‐positive patients with a history suggestive of acute appendicitis should not be treated differently from the normal population. Morbidity and mortality can be minimized by prompt surgical treatment.
EXTRACRANIAL REPAIR OF CEREBROSPINAL FLUID RHINORRHOEA
Authors: Bartley J. 
Published: January 2008

Background:Extracranial techniques, which have none of the inherent morbidity associated with intracranial techniques, can successfully repair rhinological cerebrospinal fluid (CSF) fistulas.Methods:A series of five consecutive adult patients with persistent rhinological CSF fistulas were reviewed retrospectively.Results:The success rate for initial closure was 60%. On the second operation both failures were successfully repaired.Conclusions:The external approach is safe, successful, alternative approach for the surgical repair of rhinological CSF fistulas.
TUMOUR CELL WOUND DISTRIBUTION AFTER COLECTOMY IN A PORCINE MODEL
Authors: Allardyce Randall A. , Morreau Philip N. , Frizelle Francis A. , Bagshaw Philip F. 
Published: January 2008

Background:Concerns over tumour implants have impeded the adoption of laparoscopic surgery for cancer. Explanations assume an increased number of malignant cells present in trocar wound sites. The following are tested in the present paper: (i) that the magnitude of wound contamination following surgery is related to the location of the tumour cells; and (ii) the surgical approach. Methods: We have used porcine sigmoid colectomy model to compare the number of tumour cells on laparoscopic wounds after resections in the presence of intraluminal, intramural and intraperitoneal 51Cr‐labelled, fixed HeLa tracer cells. Open colectomies were also performed in the presence of intraperitioneal tracer cells and their numbers on laparotomy wound surfaces were determined by gamma counting.Results:With intraperitoneal cells, laparotomies had 1087 (± 106) tracer cells per mm (n= 4) while trocar wounds had 103 (± 54) cells per mm (n= 10) (P > 0.05). Resection of intramural tumours resulted in lower trocar wound contamination (0.9 ± 0.6 cells/mm, n= 3). Resection of colon including intraluminal tracer cells resulted in 2.9 ± 2.1 cells/mm on trocar wounds (n= 3).Conclusions:More tumour cells were deposited on open than laparoscopic trocar wound surfaces. Also, the risk of wound implantation is less with intraluminal or intramural tumours than with intraperitoneal cells (P > 0.05).
ROUTINE CHOLECYSTOCHOLANGIOGRAPHY: A VIABLE ALTERNATIVE DURING LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Young Christopher , Moont Michael 
Published: January 2008

Background:The advantages of cholangiography during laparoscopic cholecystectomy (LC), including identification of biliary anatomy and biliary calculi, are well known. The usefulness of cholecystocholangiography (CCC), by direct injection through the gallbladder, compared to the more popular cystic duct cholangiography (CDC), however, is not so well known.Methods:Two hundred consecutive patients who underwent LC were included in a prospective study of routine CCC. Between 5 and 60 mL of contrast is injected through the gall‐bladder fundus, using image intensifier control.Results:Cholecystocholangiography was attempted in 194 cases and was successful in 157 (80.9%). Twenty‐one of the 37 cases with a failed CCC proceeded to have a successful CDC, giving an overall cholangiography success rate of 91.8%. The presence of acute inflammation decreased the success rate. Eleven (6%) true positive cases of common bile duct (CBD) calculi were demonstrated (nine on CCC and two on CDC after failed CCC). There was one case of false positive CBD calculus and no false negatives.Conclusions:We have found that the routine use of CCC during LC is safe, successful, quick to perform, and does not prevent conversion to attempted CDC in the cases where it fails. Cholecystocholangiography may have advantages over CDC and be an alternative as the preferred imaging technique.
THE SIGNIFICANCE OF DONOR LEG DISTAL RUNOFF IN FEMOROFEMORAL BYPASS GRAFTING
Authors: Thompson‐Fawcett Mark , Moon Marc , Hands Linda , Collin Jack 
Published: January 2008

Background:The aim of this study is to determine if femorofemoral bypass grafting is an effective operation for unilateral iliac occlusive disease, and to assess for factors that may predict a poorer outcome. A retrospective review was conducted of cases identified from a prospective audit database.Methods:Information was obtained from the clinical notes of 97 patients who had 100 femorofemoral bypass graft operations. All living patients were invited for assessment which included colour duplex sonography of the graft and measurement of the ankle brachial index.Results:Using life‐table analysis, the five‐year graft secondary patency for claudicants was 79% and for those with critical ischaemia 78%. Five‐year survival for claudicants was 65% and for those with critical ischaemia, 38%. Poor distal runoff in the infrapopliteal arteries of the donor limb adversely affected graft patency. Graft survival was not affected by the indication for operation, by donor or recipient superficial femoral artery patency, or by the need for endarterectomy, pre‐operative angioplasty or the graft material.Conclusions:Femorofemoral bypass grafting is the procedure of choice for all patients who require surgical intervention for unilateral iliac occlusion and donor limb distal runoff may be an important determinant of graft patency.
LAPAROSCOPIC INGUINAL HERNIOPLASTY: A COMPARISON BETWEEN TRANSPERITONEAL AND EXTRAPERITONEAL TECHNIQUES
Authors: Cocks John R. 
Published: January 2008

Background:This study sequentially compares the results of 148 transperitoneal inguinal hernioplasties in 129 patients with 313 totally extraperitoneal hernioplasties in 254 patients.Methods:Patients were entered into the study prospectively and reviewed postoperatively at 1 day, 1 week, 5 weeks and 1 year.Results:There was no difference in length of hospital stay, postoperative analgesia requirements or the rate of early or late operative complications. The operating time was shorter and the return to normal activities was earlier for the totally extraperitoneal group. There were no intraperitoneal complications following the totally extraperitoneal operation.Conclusions:The extraperitoneal technique is favoured over the transperitoneal technique for laparoscopic inguinal hernioplasty.