bluuebunny/crossref_metadata_2025_split huggingface dataset:
NS17 SURGERY REMAINS THE TREATMENT OF CHOICE FOR AVMS?
Authors: Morgan M. 
Published: April 2007

The reported annual risk of haemorrhage for conservatively managed AVMs varies from less than 1% to more than 33% depending on the combination of the presence or absence of some of the following variables: haemorrhagic presentation, presence of aneurysms, the presence of exclusive deep venous drainage, and a deep location was deep. Over time, the acquisition of wear‐and‐tear associated pathologies increases the risk of haemorrhage for those that initially present with a low haemorrhage risk. It is likely that the long‐term risk is in excess of 50% over 20 years. The combined morbidity and mortality from haemorrhage is 50%.Once an AVM has been diagnosed there are four treatment options to be considered to eliminate the risk of haemorrhage. Surgery, focussed irradiation, embolisation or a combination of treatments. Consideration needs to be given to both the likelihood of haemorrhage risk elimination and the time to achieving this goal and morbidity of the procedure.Surgery for Spezler Martin grades less than 3 have close to 100% likelihood of cure and a risk of treatment morbidity less than 5% of surgery for the vast majority of cases. This result is unlikely to be approached by other modalities. For grades above 2 AVMs when the nidus is less than 3 cm, without feeding artery aneurysms or recent haemorrhage and has lenticulostriate supply, focussed irradiation is likely to be the treatment of choice. But for all other AVMs surgery remains the only reliable curative option. Combination treatments are ineffective in reducing the risks except when embolisation precedes surgery.
NS02 UPDATE ON CEREBRAL VASOSPASM
Authors: Dorsch N. W. C. , Murray M. 
Published: April 2007

Purpose  To review the incidence of vasospasm after cerebral aneurysm rupture, and compare the results with a previous review.Methodology  An online search of articles from 2001 to 2006 with “cerebral vasospasm” as key words.Results  From 75 studies involving 10717 SAH patients, delayed ischaemia was reported in 3257, or 30.4%. In a previous review of 32188 reported cases up to the early 1990s, the incidence was 32.5% (1). Those data excluded patients treated with calcium antagonists, which on the other hand were used in at least 3600 of the present 10717.Therapeutic possibilities include endothelin antagonists. In a trial of clazosentan the incidence of angiographic vasospasm was reduced, but outcome was unchanged. A controlled trial of MgSO4 showed delayed cerebral ischaemia in 24% of controls and 17% treated, and a 23% risk reduction for poor outcome. In two studies of statins there was significantly less DID in treated groups, and a 75% reduction in death rate with pravastatin treatment. Results of these and other trials, including implantation of slow‐release pellets, lamina terminalis fenestration and variations of CSF drainage, will be presented in detail.Conclusions  Promising therapeutic options for vasospasm are under study, but there is still no universally effective treatment. The incidence of delayed ischaemia has not changed much over the decades, but the clinical impression is that the problem of vasospasm is less now than 20 to 30 years ago. This may be due to improved fluid management – patients are usually treated with at least mild hypervolaemia rather than the considerable dehydration that was the norm in the 1960s and 70s.
NS03 EXPERIENCES IN JAVA
Authors: Dorsch N. W. C. , Dorsch B. L. 
Published: April 2007

Over the last four years we have spent three periods of a month or more doing voluntary work in Indonesia, mainly at the principal public hospital in Bandung, the capital of the West Java province. There are in Indonesia a similar number of neurosurgeons to Australia for over 10 times the population, a situation like much of the developing world. Three large training centres are attempting to redress the balance. At Bandung there are usually 40 or more training residents for a unit with about 60 neurosurgical beds. Our air fares are subsidised by the US based Foundation for International Education in Neurological Surgery, and accommodation by the local unit.There is a vast amount of neurosurgical material, half or more of it trauma. Road conditions are not the best, and seat belt and helmet laws basic and often not observed. In the absence of folate supplements in pregnancy, neural tube defects are common and often quite gross. Tumours are usually very large before coming to treatment, and vascular work is in its infancy, although more progressed in the private system. Examples of all these pathologies will be presented. Rehabilitation is at a level similar to Sydney 40 years ago. On our last visit, in May–June 2006, we spent a week in Jogjakarta some days after the earthquake there, dealing mainly with a large backlog of spinal injuries. There is one spinal unit in Indonesia, several hours flight away in the capital, Jakarta.We have found the people uniformly very pleasant and friendly, and appreciative of our efforts. We are always well looked after and feel perfectly safe. We can thoroughly recommend this kind of work in our region, for any age but perhaps more so for those winding down towards retirement.
NS07 CHRONIC SUBDURAL HAEMATOMAS AND ANTICOAGULATION OR ANTI‐THROMBOLYTIC THERAPY
Authors: Amato D. P. , Rust T. , Kiemer N. , Erasmus A. 
Published: April 2007

Purpose  The use of anticoagulant therapy as a causative agent in the development of chronic subdural haematomas (CSDH) was investigated. We suspected a high incidence of anticoagulant therapy or anti‐thrombotic therapy in patients who presented with CSDH.Methodology  Retrospective analysis of charts of eighty‐one cases of CSDH admitted to the neurosurgical unit of the Royal Hobart Hospital (RHH), Tasmania, Australia, over a 5‐year period were reviewed. A database of neurosurgical procedures performed at RHH was examined to retrieve these patients undergoing surgery for CSDH. We found that anticoagulant therapy was used by a significant percentage of CSDH patients.Results/Conclusions  In the patient group presenting to our unit the risk of developing a CSDH was at least 42.5 times higher in warfarinised patients and also increased for patients on aspirin, although the risk could not be quantified.
NS08 ARE CHRONIC SUBDURAL HAEMATOMAS MORE COMMON ON THE LEFT THAN ON THE RIGHT?
Authors: Kathiravel Y. , Weerakoddy Y. , Macfarlane M. R. 
Published: April 2007

Purpose  Subdural haematomas (SDHs) – acute, subacute and especially chronic subdural haematomas (CSDHs) are common lesions encountered in a neurosurgical service.The diagnosis, aetiology, management and prognosis of SDHs including CSDHs are well documented but there few reports documenting the laterality of SDHs and particularly of CSDHs.Methodology  We analysed all the cases of SDHs (that were operated on and those managed conservatively) that presented to the neurosurgical service at Christchurch Hospital between 1st January 1996 and 30th June 2006.We present the number of cases of acute, subacute and CSDHs as well as the age, gender and sides of distribution of the SDHs.Results  Of the 413 patients, 275 (66.6%) were male and 138 (33.4%) were female. They presented with 450 cases of acute, subacute, and CSDHs. The age range for all SDHs was 3 months to 95 years, with the mean age 50.9 +/− 25.8 years for acute SDH, 65.4 +/− 19.8 years for subacute SDH and 68.9 +/− 19.7 years for CSDHs. There were 150 (33.3%) acute SDHs, 38 (8.4%) subacute SDHs and 262 (58.2%) CSDHs. There was a male predominance in the acute SDH group (72.7%), equal gender distributionin the subacute SDH group and a male predominance in the CSDH group (65.3%). The majority (82.1%) of SDHs were unilateral. CSDHs were more frequent on the left side, with 57.2% of cases compared with 42.7% on the right, this being statistically significant (p = 0.03). Neither the acute nor the subacute SDHs manifested this pattern. In this paper, we discuss the likely reasons why CSDHs have a left‐sided predilection.
PS01 RESCUE HYPOTHERMIA REDUCES ILEAL INJURY IN EXPERIMENTAL INTESTINAL ISCHAEMIA AND REPERFUSION
Authors: Stefanutti G. , Pierro A. , Parkinson E. J. , Smith V. V. , Eaton S. 
Published: April 2007

Aim  Moderate hypothermia is beneficial when applied throughout intestinal ischaemia‐reperfusion (IR). However, therapeutic intervention is usually possible only after ischaemia has occurred. The aim of this study was to evaluate the efficacy of hypothermia as a rescue therapy for intestinal IR.Methods  Adult rats were ventilated via a tracheostomy and underwent either intestinal ischaemia‐reperfusion (60 min superior mesenteric artery occlusion, and 120 min reperfusion) or sham operation. Rats in the hypothermia groups were maintained at normothermia (36–38°C) throughout ischaemia, and were cooled at the beginning of reperfusion until reaching target temperature (moderate hypothermia: 30–32°C). Four groups (n = 8 each) were studied: 1) control normothermia; 2) IR normothermia; 3) control hypothermia; 4) IR rescue hypothermia. The degree of histological injury in terminal ileum was assessed on a semi‐quantitative scale (1 = low; 5 = high) by three blinded observers. Data (median [IQ range]) were compared by Kruskal‐Wallis test with Dunn’s post‐test.Results  Intestinal IR at normothermia caused severe injury to the ileum (4.5 [4–5]) compared to both normothermic (2 [1.5–2], p < 0.01 vs. IR normothermia) and hypothermic controls (2 [1.5–2], p < 0.01 vs. IR normothermia). However, rescue hypothermia offered considerable protection from IR injury, so that intestinal architecture was partly preserved (3 [2.5–4], p = n.s. vs. control normothermia; p = n.s. vs. control hypothermia).Conclusions  Moderate hypothermia reduces the extent of tissue injury following intestinal ischaemia, even when applied as a rescue therapy. It could be considered as a possible therapy in clinical conditions associated with intestinal IR.
PS15 PAEDIATRIC GUN SHOT INJURIES IN NEW ZEALAND: A DEMOGRAPHIC ANALYSIS OF AN AVOIDABLE CAUSE OF SIGNIFICANT CHILDHOOD MORBIDITY
Authors: Skinner A. M. , Hamill J. , Samarakkody U. , Kim E. , Bowkett B. , Beasley S. 
Published: April 2007

Purpose  New Zealand has a reputation for an outdoors lifestyle that includes hunting and tramping. New Zealanders own over a million guns and these are widely distributed throughout the rural and urban communities. Although its gun laws are not liberal, children still suffer gun shot injuries. The aim of this study was to examine the injuries children receive from firearms in New Zealand, their circumstances and long term morbidity.Methodology  A retrospective review of all children admitted to the four New Zealand paediatric surgical hospitals (at Auckland, Hamilton, Wellington and Christchurch) with gun shot injuries over 10 yr period 1996–2005 was undertaken. Data were compared with published literature from elsewhere.Results  Overall, the incidence of gunshot injuries in New Zealand is low compared with many other developed countries. The majority are caused by air rifles. Most are superficial but some may lead to long term morbidity.Conclusions  Although New Zealand gun laws require air rifle owners to be over 18 yrs of age, children often are victims of air rifle misuse, particularly in urban areas. Mortality is rare, but some children suffer long term morbidity. Our data may enable preventative measures to be better focused.
PS04 DELAYED DIAGNOSIS OF ANORECTAL MALFORMATION: THE NEED FOR CAREFUL NEONATAL EXAMINATION
Authors: Etheridge C. E. , Holland A. J. A. , Soundappan S. V. S. 
Published: April 2007

Purpose  To determine the frequency of delayed diagnosis of anorectal malformation in infants admitted to our institution and determine the resulting morbidity and mortality.Methodology  A retrospective review was performed of all anorectal malformations treated at the Children’s Hospital at Westmead between November 1995 and November 2006. A detailed review was performed of those infants in whom the diagnoses was made greater than 24 hours after birth.Results  175 anorectal malformations were seen at this institution over the 11 year review period. Diagnostic delay occurred in 5 (3%): four of which were male. The four males were diagnosed within the first week of life, presenting with abdominal distension, vomiting and intestinal obstruction. The single female was diagnosed at 6 months of age when at onset of solid foods she became acutely obstructed. Delayed diagnosis was found to complicate the surgical repair and may have contributed to functional and psychological issues for patients and their families. One case of delayed diagnosis resulted in the death of the child.Conclusion  Delayed diagnosis of anorectal malformations should be entirely avoidable but occurred in 3% of all cases presenting to our institution. It was associated with morbidity and even mortality. Careful inspection of the neonatal perineum at birth should allow all anorectal malformations to be consistently detected.
PS07 URACHAL ANOMALIES IN CHILDREN
Authors: Yapo B. R. , Gerges B , Holland A. J. A 
Published: April 2007

Purpose  Urachal anomalies present infrequently and may be associated with morbidity. We present the experience of our institution in the diagnosis and management of urachal anomalies.Methodology  A retrospective review of children presenting to this institution with symptoms secondary to a presumed urachal anomaly between June 1995 and June 2006.Results  There were 25 children over a period of 11 years with a likely diagnosis of anomaly at presentation. Ages ranged from 3 days to 13 years with 14 males and 11 females presenting with a granulomatous polyp (16 cases), umbilical discharge (5), umbilical infections (2), and abdominal pain (2). One case was diagnosed incidentally during a renal ultrasound. The main investigative tool was ultrasound (10), followed by micturating cystourethrogram (MCUG) (2). Fourteen of the 25 children had a patent urachus confirmed by subsequent further imaging or surgery. There was no adverse outcome from operative intervention.Conclusions  This review confirmed that whilst clinical examination remain important in the management of a child presenting with a possible urachal pathology, in 36% of the cases the correct diagnosis was only made with further radiological imaging or at operation. Surgical excision was effective with no morbidity or mortality.
PM02 RECURRENT RECTAL CANCER – STRATEGIES FOR PAIN MANAGEMENT
Authors: Heriot A. G. 
Published: April 2007

Introduction  Despite improvement in management of primary rectal cancer, local recurrence remains a significant problem. The aim was to address strategies for pain management in patients with recurrent rectal cancer.Methods  A literature search was performed using Medline, Embase, Ovid, and Cochrane database for studies between 1980 and 2005 assessing pain management of local recurrence of rectal cancer and the evidence was critically evaluated in the light of clinical experience in tertiary colorectal centres.Results  Nearly 50% of rectal cancer pelvic recurrences are local and are therefore potentially amenable to curative resection. Preoperative imaging with MRI and PET is essential for appropriate selection of patients for surgery and preoperative adjuvant therapy is important. Five year survival following resection ranges from 18%–58% though morbidity ranges from 21% to 82%. Palliative resection is usually inappropriate. Radiotherapy has an important role in the local control of irresectable local disease. Pain management of advanced pelvic disease, particularly with sacral nerve root invasion, remains difficult and often necessitates a multidisciplinary and multimodality approach. Aggressive surgical treatment favourably affects quality of life and is cost effective for irresectable local disease.Discussion  Surgery for local recurrence can result in significant survival with acceptable morbidity and improved quality of life in appropriately selected patients. Pain management of advanced pelvic recurrence is complex and should be multidisciplinary.
PR01 “A PICTURE SPEAKS A THOUSAND WORDS”– THE USE OF DIGITAL PHOTOGRAPHY AND THE INTERNET IN MONITORING FREE TISSUE TRANSFER
Authors: Varkey A. , Tan N. C. , Girotto R. , Tang W. C. , Liu Y. T. , Chen H. C. 
Published: April 2007

Purpose  Post operative monitoring is crucial for the success of microsurgical free tissue transfer. Sophisticated and expensive methods are available for monitoring. We propose a novel technique using digital photography and the internet as a reliable and cost effective method to monitor free tissue transfers.Methods  163 micro‐vascular procedures were monitored using this technique over 8 months. Serial photographs taken to show flap color. Capillary refill time, pin prick‐ bleed time and color and hand held Doppler signal was recorded in the movie mode of a standard 5 mega pixel camera with duration of 15 seconds. Data was sent to the surgeon at regular intervals and or as deemed necessary.Results  Analysis of the 67 cases is presented. 5 re‐explorations were done. The early diagnosis of venous congestion was possible using this technique. Timely intervention contributed to the success of the re‐explorations and these flaps could be salvaged. The file size of images was in the range of 1 MB–6 MB. The file size of an entire set of images ranged about 7 MB–9 MB. These were sent across the ADSL internet lines.Conclusion  The use of the digital images and the internet allow reconstructive surgeons to have a reliable picture of the state of their free tissue transfers. This permits decrease in observer error and saves valuable time which otherwise needs to be spent to verify situations of doubt and offers an ideal solution to the logistic problem of having to visit the patient in case of doubt.
PR11 PREOPERATIVE IMAGING FOR DIEA PERFORATOR FLAPS: A COMPARATIVE STUDY OF CT ANGIOGRAPHY AND DOPPLER ULTRASOUND
Authors: Rozen W. M. , Phillips T. J. , Ashton M. W. , Stella D. L. , Gibson R. N. , Taylor G. I. 
Published: April 2007

Background  Abdominal donor site flaps, including the Transverse Rectus Abdominis Musculocutaneous (TRAM) and Deep Inferior Epigastric Artery (DIEA) perforator flaps, are the standard in autologous breast reconstruction. With variation in the vascular anatomy of the abdominal wall, preoperative imaging is essential for preoperative planning and reducing intraoperative error. Ultrasound has been used previously with varying results, and the quest continues for optimal preoperative assessment. Computerised Tomography Angiography (CTA) has been recently proposed as a non‐invasive modality for this purpose. This is the first study to formally compare preoperative Doppler ultrasound with CTA for imaging the DIEA.Methodology  Eight consecutive patients undergoing DIEA perforator flaps for breast reconstruction undertook both CTA and Doppler ultrasound preoperatively. All investigations and procedures were undertaken at the same institution with the same surgeon and radiology team.Results  CTA was superior at identifying the course of the DIEA, its branching pattern and in visualizing its perforators than Doppler ultrasound. Preoperative CTA was highly specific (100%) and more sensitive in mapping and visualising perforators (p < 0.001). CTA was also proficient at identifying the superficial epigastric arterial system and for effectively displaying the results intraoperatively. CTA was substantially quicker and removed the inter‐observer error associated with Doppler ultrasonography. The study was ceased after eight patients due to the overwhelming benefit of CTA over Doppler.Conclusions  CTA is a valuable imaging modality for the preoperative assessment of the donor site vascular supply for TRAM and DIEA perforator flaps.
PR16 A TRAUMA CENTRE EXPERIENCE: FLAP RECONSTRUCTION OF TRAUMATIC LOWER LIMB INJURIES
Authors: Lo C. H. , Leung M. , Baillieu C. , Chong E. W. T. , Cleland H. 
Published: April 2007

Purpose  Decision making in the management of combined major skeletal and soft tissue trauma to the lower limb is a complex process made more difficult by the uncertainty surrounding outcomes. The aim of this study is to review and present our experience with flap reconstruction of traumatic lower limb defects, with particular reference to in‐hospital complications and outcomes related to timing, choice of flap and pre‐existing complications.Methodology  Retrospective review of all lower limb flap reconstructions performed by the Plastic and Reconstructive Surgery Unit at the Alfred Hospital (largest trauma centre in Australasia) from 1 July 2001 to 20 October 2005 (51 month period).Results  Sixty‐four patients had 83 flap reconstructions (35 free, 48 local) of 70 separate lower limb injuries. Twenty‐seven flaps (32.5%) developed soft tissue infections and 16 fixation devices (25.8%) were complicated by deep metal infection. There were 6 (12.5%) local flap partial necrosis and 4 (11.4%) free flap failures. Three patients underwent secondary amputation during their initial admission. Thorough wound debridement and internal skeletal fixation were followed by earlier soft tissue coverage and lower deep metal infection rates. Limbs in which flaps were performed after Day 5 were more likely to develop deep metal infection (p = 0.04) and suffer free flap failure or local flap partial necrosis (p = 0.02).Conclusion  The current study presented our experience with flap reconstructions of complex lower limb injuries at a major trauma centre. Thorough wound debridement, internal fixation and early soft tissue coverage (within 5 days of injury) is associated with lower infection rates and optimal outcomes.
PR21 ROLE OF BACTERIAL BIOFILMS IN CHRONIC WOUNDS
Authors: Ngo Q. , Vickery K. , Deva A. K. 
Published: April 2007

Purpose  Bacterial biofilms are highly organised microbial communities living within a protective extracellular matrix. They are difficult to detect and highly resistant to immune or antibiotic killing. It has been suggested that biofilm presence may contribute to the intractable inflammatory processes seen in chronic wounds.Method  Twelve chronic wound samples from eight different patients were collected as part of routine debridement. These were examined for biofilm presence using light microscopy, confocal laser scanning microscopy, electron microscopy, and Fluorescent In Situ Hybridisation (FISH) technique. Microbiological profiles were established based on wound swabs.Results  Histological and microscopic evidence of bacterial biofilms were observed in 7 out of 12 wounds. These were mostly found within the necrotic upper layer of the wound. A range of organisms were identified from swabs including the commonly isolated wound bacteria S.aureus, E.Coli, P.aeruginosa, and mixed anaerobes.Conclusion  Bacterial biofilms were found in almost two‐third of chronic wounds examined. Given the patchy nature of its occurrence and the small area sampled in each biopsy, the true incidence could be much higher. The necrotic surface layer of wounds appeared to be more conducive to biofilm formation than deeper viable tissues. Such biofilms may then serve as niduses for continual bacterial seeding that perpetuate the inflammatory process seen in these wounds.