bluuebunny/crossref_metadata_2025_split huggingface dataset:
VENTILATION TUBE DURATION VERSUS SITE OF PLACEMENT
Authors: Walker Paul 
Published: January 2008

Background: The duration a ventilation tube remains in the tympanic membrane is thought to be related to the design of the ventilating tube, and to the site of placement of the ventilation tube into the tympanic membrane. Theoretically a ventilating tube placed superiorly should remain longer than one placed inferiorly. Methods: A prospective study was designed to test the hypothesis that ventilation tubes placed into the antero‐superior quadrant of the tympanic membrane remained longer than those placed into the antero‐inferior quadrant. Results: In 106 children no statistically significant difference in duration was identified using three designs of ventilation tube. Conclusions: Ventilating tubes placed antero‐superiorly into the tympanic membrane do not have a longer duration than those placed antero‐inferiorly.
LAPAROSCOPIC MANAGEMENT OF BLUNT DIAPHRAGMATIC INJURY
Authors: Lindsey Ian , Woods Simon D. S. , Nottle Peter D. 
Published: January 2008

Background: Diaphragmatic injury is difficult to diagnose using current radiological modalities, and missed diagnosis has been associated with a mortality of 20–36%. Laparotomy is the most sensitive of the standard diagnostic tools, but its unnecessary use can be up to 25% and carries a morbidity of 20%. Methods: The use of the laparoscope in three cases of blunt diaphragmatic injury is reported here. Two cases were non‐acute. The diagnosis of diaphragmatic injury could not be confirmed pre‐operatively in any of the cases. Results: One, a left‐sided injury, was easily diagnosed and repaired laparoscopically. The second, right‐sided, was confirmed laparoscopically but had to be repaired by open due to difficulty with liver retraction. The third case, an acute injury, was not diagnosed at laparoscopy. Findings of free blood and distended small bowel warranted laparotomy and prevented the establishment of a safe, satisfactory pneumoperitoneum. Repair was performed open. None of the cases was complicated by pneumothorax. Conclusions: Laparoscopy is a useful tool for diagnosis of non‐acute blunt diaphragmatic injury but has limitations in the acute setting. Left‐sided injuries can be repaired laparoscopically but right‐sided injuries proved difficult and may be better dealt with thoracoscopically.
GROWTH DISTURBANCES ASSOCIATED WITH UNTREATED BENIGN BONE CYSTS
Authors: Clayer M. , Boatright C. , Conrad E. 
Published: January 2008

Background:The occurrence of benign bone cysts adjacent to an active physis may be associated with a physeal arrest. That arrest may result from physeal penetration of the cysts itself, secondary pathologic fracture or the result of surgical curettage. Methods: The pre‐treatment X‐rays of patients attending the Bone Tumor Clinic at the Children's Hospital and Medical Center were reviewed. Those patients presenting with a bone cyst were identified and the affected side was compared to the normal side in order to determine growth discrepancies. Results:Three cases of benign bone cysts are presented that were located adjacent to a growing physis and produced growth disturbance in the absence of surgical intervention. Conclusions:The risk of growth disturbance in itself should not be a contraindication to surgical intervention.
PERITONITIS FOLLOWING PERCUTANEOUS GASTROSTOMY IN CHILDREN: MANAGEMENT GUIDELINES
Authors: Kimber Chris P. , Khattak Irfan U. , Kiely Edward M. , Spitz Lewis 
Published: January 2008

Background: To establish the incidence, timing and outcome of peritonitis following percutaneous gastrostomy (PEG) insertion in children. Methods: Patients developing peritonitis after PEG insertion during a 5‐year period (1990–95) were identified. Variables analysed included clinical presentation, management, operative findings and outcome. Results: One hundred and twenty paediatric patients received 130 PEG in the 5‐year period. Eight children developed peritonitis: 4 within 24 h of PEG insertion and 4 following routine PEG tube change (3–18 months later). All four patients developing early peritonitis underwent laparotomy in whom three had sustained major damage to adjacent viscera. The fourth patient had a negative laparotomy, but died from continued overwhelming sepsis. All four patients who developed peritonitis after a routine tube change underwent a tube contrast study. In two children a gastrocolic fistula was identified and surgically repaired. Contrast studies in two patients detected an intraperitoneal leak. This problem resolved with conservative management in both cases. Conclusions: Peritonitis immediately following PEG insertion is rarely due to the air leakage during insertion (benign pneumoperitoneum) and warrants early laparotomy to identify and correct the likely associated visceral trauma. Following PEG tube change peritonitis may result from stomal separation or tube malposition and an urgent study is indicated to identify the cause.
ONE HUNDRED LIVER RESECTIONS INCLUDING COMPARISON TO NON‐RESECTED LIVER‐MOBILIZED PATIENTS
Authors: Hardy Kenneth J. , Fletcher David R. , Jones Robert McL 
Published: January 2008

Background: Factors of liver resection associated with postoperative recovery and survival, the modalities that affect survival with resected colorectal carcinoma liver metastases, the comparison of liver function of liver‐resected to liver‐mobilized but not resected patients, and observation of early liver regeneration volume over time have not been studied prospectively. This study aimed to prospectively analyse these factors. Methods: Data were collected prospectively on 100 consecutive liver resections, and 10 liver‐mobilized but not resected patients by the Hepatobiliary Unit, University of Melbourne, Austin Campus. Follow‐up of patients was 100%. Results: The factors associated with blood loss were the type of liver resection (P= 0.0001), the length of the operation (P= 0.0001) and a central venous pressure greater than 5 cm of water (P= 0.0008). An inverse correlation existed between blood loss and long‐term survival (P= 0.003). The only predictor for a postoperative complication was the length of the operation (P= 0.03): a correlation of moderate significance existed between blood loss and a complication (P= 0.052; confidence interval 0.19–1.17). The 5‐year cumulative survival for hepatic resection for colorectal carcinoma Dukes A + B was 55%; there was a significantly better survival of Dukes A + B compared to Dukes C (P= 0.03) and also for those 50 years or older, but this did not depend on whether there were one or more lesions present. Resected patients had a significantly higher alanine transaminase (ALT), total bilirubin and international normalized ratio than non‐resected patients, but not albumin, total protein, alkaline phosphatase or aspartate aminotransferase. The serum albumin fall was similar in both groups, which indicated that loss of liver tissue was not the cause. The re‐resection rate was 8% without mortality and with low morbidity. Liver volume was restored by 64% (510± 170cc) by 7 days postoperatively. Conclusions: Major hepatic resection can be performed with low mortality, morbidity and short hospital stay, with a 5‐year survival for colorectal carcinoma better than 50%. Resection needs to be considered more frequently for curative management. Serum albumin fall is not caused by loss of liver tissue and blood loss can be controlled by central venous pressure manipulation and vascular isolation. Re‐resection is a safe and rewarding treatment and needs to be planned at the first resection.
INFORMED CONSENT: HOW MUCH INFORMATION IS ENOUGH?
Authors: Stanley B. M. , Walters D. J. , Maddern G. J. 
Published: January 2008

Background: Recent judicial decisions involving informed consent have led to some medical practitioners altering the way they obtain consent. The aim of this study was to determine the degree to which patients understood the risks associated with a surgical procedure after giving routine consent and whether providing additional detailed verbal and/or written information improved their understanding. It was further determined whether the provision of more extensive information altered patients' anxiety levels. Methods: Patients undergoing femoral popliteal bypass or carotid surgery were randomized to obtain either routine consent only or routine consent with verbal or written or verbal and written consent. Patients undertook a pre‐operative risk and complication questionnaire, a pre‐ and postoperative anxiety and depression evaluation and a follow‐up questionnaire 6 weeks after discharge. Results: Thirty‐two patients were included in the trial. The comprehension questionnaire resulted in a correct percentage response of 48% for the routine information only, 59% with added verbal information, 59% with added written information and 55% with added written and verbal information. Twenty‐five per cent of patients stated that they had a poor understanding of the risks and complications of the procedure. Conclusions: Additional written or verbal information did not improve a patient'understanding of risks and complications of the procedure. It also did not improve patients' perceived understanding of the operation or its complications. Patients' anxiety levels were unaltered by the increase in the information they were given. The information provided to patients should be simple, easy to understand and list any possible major complications to enable the patient to determine whether to undergo or decline a procedure.
MANAGEMENT OF ANORECTAL FOREIGN BODIES: A CAUSE OF OBSCURE ANAL PAIN
Authors: Ooi Boon‐Swee , Ho Yik‐Hong , Eu Kong‐Weng , Nyam Denis , Leong Adrian , Seow‐Choen Francis 
Published: January 2008

Background: Few patients with anorectal foreign bodies will freely admit to transanal introduction. The results of long‐term follow‐up in these patients have been sparse. Methods: Data from April 1989 to April 1997 were extracted from a prospective computerized database. The clinical features and the results of a departmental management protocol for anorectal foreign bodies were analysed. In addition, long‐term outcomes were obtained by telephone interview. Results: Thirty patients (25 men, 5 women) with a mean age of 46 (range 16–72) years) were treated for this condition. While 10 patients (33.3%) admitted to transanal insertion, the remaining 20 (66.7%) complained of anal pain. Among the latter, the foreign body was subsequently found on routine digital rectal examination in nine patients (45%), on X‐ray in nine (45%) and it was passed out unexpectedly after fleet enema in two (10%). Factors which raised suspicion for X‐rays included atypical gender behaviour, lax anal sphincters and bloody or mucoid rectal discharge. Transanal recovery was successful with sedation in 12 (40%), general anaesthesia in 13 (43.3%), and laparotomy was needed in three (10%; which included one perforated bowel at presentation). There were two complications (6.7%; one minor rectal abrasion and one bronchopneumonia). There was no long‐term faecal incontinence or re‐impaction of foreign bodies at 63 (range 8–96) months of follow‐up. Conclusions: Foreign bodies should be suspected in patients with obscure anal pain. Judicious transanal extraction under sedation or general anaesthesia was usually successful with minimal short‐and long‐term complications.
PRE‐OPERATIVE CORE BIOPSY OF SOFT‐TISSUE TUMOURS FACILITATES THEIR SURGICAL MANAGEMENT
Authors: Serpell Jonathan W. , Pitcher Meron E. 
Published: January 2008

Background:Soft‐tissue sarcomas are rare, and clinical differentiation of benign tumours from sarcomas is sometimes impossible. Further, the diagnosis of soft‐tissue sarcomas may be unsuspected pre‐operatively, and the presenting mass enucleated. While enucleation (excisional biopsy) is acceptable for benign lesions, it is inappropriate for sarcomas, because the opportunity for the most effective management resulting in both adequate local control and functional limb salvage surgery is compromised. A high rate of wound complications following open incisional biopsy may also compromise local treatment. Inappropriate siting of the incision for both incisional and excisional biopsies may adversely affect subsequent surgery and radiotherapy.Methods:We therefore assessed the accuracy of core biopsy in the diagnosis of soft‐tissue tumours, and planning of definitive surgery. All patients with primary soft‐tissue tumours managed by two surgeons with a special interest in soft‐tissue sarcomas since 1991 were reviewed. More than half (53%) were referred from other specialists.Results:Of 45 cases, 37 (82%) were referred with the tumour intact, and of these 31 (84%) underwent core biopsy. The overall accuracy of core biopsy was 84%. The sensitivity was 94%, with 100% specificity. In most patients this allowed planning of definitive one‐stage surgery (P < 0.005). Of the remaining five non‐diagnostic cores, four were benign and one was a non‐specific malignancy.Conclusions:Core biopsy has a high degree of accuracy in the diagnosis of soft‐tissue tumours, particularly malignant lesions, and is not misleading. Core biopsy avoids the complications of open biopsy, and enables planning of one‐stage surgery when used in combination with appropriate imaging.
MANAGEMENT OF INVASIVE PENILE CANCER BY SYNCHRONOUS PENILE LENGTHENING AND RADICAL TUMOUR EXCISION TO AVOID PERINEAL URETHROSTOMY
Authors: Donnellan S. M. , Webb D. R. 
Published: January 2008

Background:Adequate excision of invasive penile carcinoma often results in penile stump of inadequate length to control the urinary stream. A simple technique to lengthen the stump and avoid urethrostomy is described here.Methods:Additional corporal length is gained by dividing the dorsal suspensory ligaments through transverse lower abdominal skin incision. Skin length is gained by vertical closure of this incision.Results:Conclusions:In selected cases this technique may avert the need for perineal urethrostomy after adequate excision of penile cancer.
SINGLE‐VERSUS MULTIPLE–DOSE ANTIMICROBIAL PROPHYLAXIS FOR MAJOR SURGERY: A SYSTEMATIC REVIEW
Authors: McDonald Malcolm , Grabsch Elizabeth , Marshall Caroline , Forbes Andrew 
Published: January 2008

Background:Single‐dose antimicrobial prophylaxis for major surgery is widely accepted principle; recommendations have been based on laboratory studies and numerous clinical trials published in the last 25 years. In practice, single‐dose prophylaxis has not been universally accepted and multiple‐dose regimens are still used in some centres. Moreover, the principle has recently been challenged by the results of an Australian study of vascular surgery. The aim of this current systematic review is to determine the overall efficacy of single versus multiple–dose antimicrobial prophylaxis for major surgery and across surgical disciplines. Methods: Relevant studies were identified in the medical literature using the MEDLINE database and other search strategies. Trials included in the review were prospective and randomized, had the same antimicrobial in each treatment arm and were published in English. Rates of postoperative surgical site infections (SSI) were extracted, 2 × 2 tables prepared and odds ratios (OR) [with 95% confidence intervals (95% CI)] calculated. Data were then combined using fixed and random effects models to provide an overall figure. In this context, high value for the combined OR, with 95% CI > 1.0, indicates superiority of multiple–dose regimens and low OR, with 95% CI < 1.0, suggests the opposite. A combined OR close to 1.0, with narrow 95% CI straddling 1.0, indicates no clear advantage of one regimen over another. Further subgroup analyses were also performed.Results:Combined OR by both fixed (1.06,95% CI, 0.89–1.25) and random effects (1.04, 95% CI, 0.86–1.25) models indicated no clear advantage of either single or multiple‐dose regimens in preventing SSI. Likewise, subgroup analysis showed no statistically significant differences associated with type of antimicrobial used (beta‐lactam vs other), blinded wound assessment, length of the multiple–dose arm (> 24 h vs 24 h or less) or type of surgery (obstetric and gynaecological vs other).Conclusions:Continued use of single–dose antimicrobial prophylaxis for major surgery is recommended. Further studies are required, especially in previously neglected surgical disciplines.
NEWLY ARISING FIBROADENOMAS IN WOMEN AGED 35 AND OVER
Authors: Foxcroft L. , Evans E. , Hirst C. 
Published: January 2008

Background:Fifty‐one cases of de novo fibroadenoma in women aged 35 years and older were found during an analysis of 117 729 visits to the Wesley Breast Clinic from 1990 to 1996.Methods:The clinical, mammographic and ultrasound diagnosis of fibroadenoma was confirmed by either fine needle aspiration cytology or histology of an open biopsy specimen. In all cases there was a well‐documented previous visit available for review, at which there was no clinical or radiological evidence of the fibroadenoma.Results:Thirty‐seven of the de novo fibroadenomas were palpable, the remainder satisfying strict mammographic and/or ultrasound criteria. Four of the new fibroadenomas were in women aged 50–52.Conclusions:This study provides information about the natural history of fibroadenomas, confirming that they can appear for the first time in middle‐aged women. This has important clinical implications, since new lesions appearing in women over 35 have tended to be automatically categorized as suspicious of carcinoma. However, a multidisciplinary approach involving clinical examination, mammography, ultrasound, and fine needle aspiration cytology or core biopsy can result in a confident diagnosis of fibroadenoma. This will allow some women with new lesions to be managed conservatively rather than by open biopsy.
ENDOSCOPIC STAPLING TREATMENT OF PHARYNGEAL POUCH
Authors: Burstin P. P. , Merry D. 
Published: January 2008

Background:We describe our experience of a recently reported endoscopic stapling technique for the treatment of pharyngeal pouch. Methods: In contrast to other endoscopic procedures, which only divide the common wall between oesophagus and diverticulum, the linear cutting stapler also tightly seals the divided edges of mucosa and muscle.Results:The procedure was performed without complications in three patients with complete resolution of pre‐treatment symptoms.Conclusions:To our knowledge this is the first report of the use of this procedure in Australia. This endoscopic stapling operation appears to be safe, simple and cost‐effective and offers advantages over previously used techniques.
The Economics of Law: Economic Imperialism in Negligence Law, No‐Fault Insurance, Occupational Licensing and Criminology?
Authors: Swan Peter L. 
Published: January 2008

AbstractThe aim is to examine the contribution which economic and quantitative analysis can make to a better understanding of the law. I concentrate on the common law action of negligence and how it is related to the optimal deterrence of accidents, rather than to the compensation of all accident victims. A critique is made of the New South Wales Law Reform Commission's proposal to prohibit negligence actions for motor vehicle accidents and to introduce a compulsory ‘no‐fault’ scheme. An econometric analysis of new Zealand and Australian ‘no‐fault’ schemes finds that the negligence system appears to have some deterrent effect on motor vehicle accidents.
An Analysis of Recent Changes in the Australian Exchange Rate: Nominal and Real
Authors: Lim G. C. , Parmenter B. R. 
Published: January 2008

AbstractRecent movements in the Trade Weighted Indexes (MI) of Australia's nominal and real exchange rates are documented. The volatility of the nominal rate in the pre‐float and post‐float periods is examined. Decompositions are made of the most recent depreciations of the Twls into compenents due to depreciations against the United States dollar ($US) and other major currencies. The extent to which the recent changes can be understood as necessary to correct misalignment in the Australian balance of payments is investigated.
Continuity and Change in Australian Wages Policy
Authors: Scherer Peter 
Published: January 2008

AbstractAustralia shares with several small European economies the characteristic of having a relatively coordinated union movement with the ability to influence real wage levels. This article explores the course of wages policy over the last decade by applying to Australia a model of wage determination originating in Europe, a model which assumes that the union movement can determine the real wage level. The wage level the union movement chooses is influenced by choices it faces between real wage increases and employment growth. The unions are also influenced by the public sector employment generating activity of government. Stagflation in the late 1970s is analysed by hypothesising a misperception by the union movement of the policy options available to government, and a mistrust by government of the unions' willingness to moderate wage increases if employment levels rise rapidly. The model suggests that an accord between unions and government (such as that which has been in place in Australia since 1983) is a way to escape some of these policy dilemmas.
Employment, The Labour Force and Unemployment in Australia: A Disagregegated Approach
Authors: Peters R. W. , Petridis A. 
Published: January 2008

AbstractThis article presents statistical analysis of the distributional aspects of labour market developments in the Australian economy from 1966 to 1985. The focus is on the adjustment of the labour force to changes in employment opportunities. Two sets of data for selected age/sex/marital groups are utilised in the analysis: regressions to test for differences in the sensitivity of labour force participation to employment opportunities and a series of tables documenting population adjusted changes in employment and the labour force. The aggregate relationship between employment changes and labour force changes (and hence changes in unemployment) is explained by the disaggregated data.
The Australian Economy on the Hinge of History
Authors: Schedvin C. B. 
Published: January 2008

AbstractThe article traces the origins of the Australian economic crisis of the 1980s, and suggests that many problems can be related to the special character of the country's long‐term economic development. The dominance of two exceptional commodities, wool and gold, created a remarkably high standard of living in the nineteenth century. But there were dangers. High labour productivity was achieved without the underpinnings of modem technology, and it was difficult to achieve sustained industrialisation from a high income base in a small, open society. Further, the efficiency of traditional commodity production helped create an inward‐looking urban‐industrial sector. Gradually fundamental change in the composition of global trade has marginalised Australia's traditional export sector. The urgent need now is for an aggressive exploitation of the country's considerable resources in science and technology. If this is achieved the 1980s could see a basic shift in Australia's economic history.
Competitive Aspects of Electronic Funds Transfer Systems: The Emerging Pattern of Point‐of‐Sale Networks
Authors: Williams Philip L. 
Published: January 2008

AbstractA system for transferring funds electronically at the point of sale is a substitute for other means by which funds can be transferred. The gateways in the EFT‐POS system being implemented by the principal Australian banks appear to deny full participation to other financial intermediaries. But the gateways may be needed if those responsible for the innovations are to secure an adequate return on their investment. Current bargaining among retailers, financial intermediaries and Telecom will determine the extent of the return which will accrue to the principal banks.