bluuebunny/crossref_metadata_2025_split huggingface dataset:
HS11 POST‐OPERATIVE HAND PAIN ASSESSMENT
Authors: Teoh L. C. 
Published: April 2007

Hand is a very heavily innervated organ. Therefore any traumatic injury or surgical insults will provoke severe pain. Adequate pain management should be given in all the cases. Early motion is always necessary in all operated hands. It is uncertain as to the causes of excessive pain occurring in some patient. It is interesting to note that a hand with complex injury require flap surgery can be less painful in comparison to a lesser crushing injury that require minor repairs.Excessive pain that is out of proportion should be identified early in the follow up. Patient with pain that is unrelenting, not relieved with NSAID and disturbs sleep (after excluding all causes of complication) is a candidate to developing CRPS. In the first 2 weeks of follow up this is the stage “nascent CRPS”.Nascent CRPS can be aborted if correctly managed. All pain provoking therapy should be stopped. Only active motion that is not pain provoking is allowed. Contact stimulation is very useful in reducing pain, it works on the basis of “gate‐control”. Self gentle rubbing of the hand on rough fabric cushion is performed hourly for 5–15 minutes. The gentle motion also moves all the normal joints in the upper limb that further suppresses pain.Excessive pain that continues beyond the duration of 6 weeks is very likely to develop into established CRPS.
HS04 THE USE OF A VISUAL HAND CHART TO AID IN COMMUNICATION OF HAND INJURIES
Authors: Friederich L. J. , Page R. D. 
Published: April 2007

The hand is one of the most commonly injured parts of the body, however in a climate of increasingly reduced anatomical teaching, junior doctors are ill equipped to assess and describe hand injuries they encounter in their Emergency Department rotations.Hand and Plastic surgery registrars are often very busy and can find it time consuming to extract the information they require from junior doctors. Their workload can be managed significantly more effectively with clear, concise and accurate descriptions of hand injuries.This study was designed to assess the effect of a visual ‘hand chart’ on junior doctor's assessment and description of common hand injuries. The chart illustrates basic underlying anatomical structures and their relevant surface landmarks, together with the appropriate anatomical terms to describe them.Two groups of 25 junior doctors were tested. Group A were shown a set of 10 digital images of simple hand injuries and asked to transcribe what they would say to the on call hand surgeon. Group B were given the visual ‘hand chart’ and tested in a similar fashion with the same set of images. Group A was later retested with the ‘hand chart’ and a second set of 10 images. Simple demographic information was also collected from participants asking their year since graduation and any prior experience with hand surgery.A marking key was used to score participants answers and the results were analysed using the students t‐test. Significant differences were found between the groups suggesting that the hand chart was a valuable aid in communication. It may thus prove useful in wider contexts, such as remote and rural medical stations.
HS06 THE CURRENT MEDICAL MANAGEMENT OF NEUROPATHIC PAIN
Authors: Acland R. H. 
Published: April 2007

This title is sure to be a turnoff for most surgeons!Neuropathic pain is a term that has been brought to prominence with the marketing of the drug, neurontin. Neuropathic along with nociceptive are two general terms used to classify pain symptoms. Nociceptive often refers to pain symptoms that are amenable to the surgical knife whereas neuropathic often involves more central mechanisms.Management of neuropathic pain is generally based around the use of prescription medication. I will briefly detail what is hot and what is not in neuropathic analgesia. Information will be provided on neuromodulation/surgical techniques that modulate central nervous system transmission. My experience of spinal cord stimulation in a case of extreme CRPS will be presented.
HS08 CONGENITAL HAND: THE DEFORMITY‐DEFICIENCY INDEX
Authors: Teoh L. C. 
Published: April 2007

Congenital hand is a complex and vast subject therefore classification is very necessary for the purpose of teaching, communication and guide treatment. The first comprehensive and yet user friendly classification was proposed by Swanson et al. in 1976. This classification based on etiopathogenic is popularly known as the ‘IFSSH 7 groups classification’. (I) Failure of formation: transverse or longitudinal (II) Failure of differentiation (III) Polydactyly (IV) Overgrowth (V) Undergrowth (VI) Amniotic band syndrome (VII) Generalized skeletal syndromes. However this classification was found not able to satisfactorily classify 20–30% of cases.Other classifications based on genetic defects, teratogenic sequence and syndromics were being introduced previously and continue to be used parallel with the IFSSH classification. Furthermore the classification continue to be besieged by multiple morphological types of deformity in a same hand. Ogino introduced the JSSH expanded classification to address some of the deficiencies of the IFSSH classification.For a beginner in treating congenital hand, it is indeed daunting, as the variations in morphology, the degree of severity and functional deficit even in the same diagnosis can be very different. It is usual to find further sub classifications.For the purpose of guiding treatment, I propose the concept of deformity/ deficiency index. Group I) The imbalance/ small in size II) Extra digits III) Mal positioned/ Mal‐aligned IV) Poor/ No function V) Total absent. The residual functional decreases from group I to V. And similarly the reconstruction becomes complex and difficult.
HN02 PATIENT RESPONSES TO THEIR MULTIDISCIPLINARY HEAD AND NECK CLINIC VISIT
Authors: Streit J. B. F. , Oates J. , David C. , Sneddon L. , Martin R. , Obrien C. 
Published: April 2007

Purpose  To prospectively assess the subjective experience of patients and the degree of benefit they felt they gained from attending the Multidisciplinary Head and Neck Clinic (MDHNC).Methodology  An internally validated questionnaire of patient responses to their experiences at the MDHNC was implemented prospectively. Data were gathered between May and September 2006. The questionnaire consisted of 36 questions, addressing 3 components of the clinic; before, during and after attendance. Twenty four of 48 questionnaires were completed.Results  Patients’ experiences of the clinic were mainly positive. All patients reported feeling adequately informed about both illness and their treatment options. No patients left with unanswered questions. All, but one patient, tolerated the examination well, although 4 patients were unprepared for the number of people present at the clinic. Twenty two patients especially valued the post‐clinic discussion with their specialist. Five patients felt that insufficient information about treatment choice was provided to their family. No discrepancy between internal validation questions was recorded.Conclusion  Patients expressed a high level of appreciation for the care provided in the multidisciplinary clinic. Contrary to our expectations, patients generally did not mind examination in the presence of a large number of clinicians. Most patients reported particularly valuing the discussion with the treating specialist after the clinic visit. Reducing waiting times, providing clearly written plans for treatment resulting from the clinic, and distributing more information to assist individuals accompanying patients, emerged as target areas for future improvement.
HN08P AUDIT OF 115 CONSECUTIVE PARATHYROIDECTOMIES IN PATIENTS WITH RENAL HYPERPARATHYROIDISM
Authors: Low T. H. , Clark J. , Gao K. , Shannon K. , O’Brien C. 
Published: April 2007

Objectives  To review the characteristics and outcomes of patients undergoing parathyroidectomy for renal (secondary and tertiary) hyperparathyroidism.Methods  Review of prospectively collected data from a dedicated head and neck database at RPAH between 1988 and 2004. A total of 115 patients underwent exploratory parathyroidectomy.Results  Common indications for parathyroidectomy included hypercalcaemia, renal osteodystrophy, calciphylaxis and calcinosis, bone or joint pain, and pruritus. Sixty‐nine patients had subtotal parathyroidectomy (STP), 47 had total parathyroidectomy (TP) of which 4 had total parathyroidectomy with autotransplant (TPA). Ten patients required re‐exploration for recurrent hyperparathyroidism at a median time to reoperation of 55 months. Of those, 8 had STP, 1 had TP, and 1 had TPA. Predictors of recurrent hyperparathyroidism included higher post operative PTH level (median of 22.5 pmol/L vs 3.4 pmol/L) and higher total parathyroid weight (median of 7.75 gm vs 2.9 gm). 97% of patients reported resolution of symptoms on follow‐up. The average length of hospital admission was 4.4 days. Morbidity of this series included wound infection (0.8%), temporary vocal cord paralysis (0.8%), seizure due to severe hypocalcaemia (0.8%) and neck haematomas requiring evacuation (0.8%).Conclusions  Parathyroidectomy is effective in the management of renal hyperparathyroidism. Subtotal parathyroidectomy is associated with a higher re‐exploration rate. Predictors for recurrent hyperparathyroidism include total parathyroid weight and post‐operative PTH level.
HP10 LAPAROSCOPIC RESECTION OF SUBMUCOSAL GASTRIC LESIONS – THE WHANGAREI EXPERIENCE
Authors: Yang J. Y. , Krishna G. 
Published: April 2007

Purpose  To evaluate safety of laparoscopic resection of submucosal gastric lesions performed in Whangarei Based Hospital.Methodology  From November 2002 to December 2006, 8 consecutive patients underwent the above mention surgery. (M : F = 5 : 3; Average age 63 [range, 43–83]). All patients underwent pre‐operative gastroscopy. Wedge resections were performed for anterior wall lesions. (n = 3). Posterior wall lesions were resected via transgastric approach. (n = 4). Retroperitoneal resection was performed for the foregut duplication cyst. (n = 1). All except one lesion were resected using endoscopic GIA stapler. The medical records of the patients were reviewed retrospectively.Results  All patients were successfully treated laparoscopically. No conversion to open surgery. Pathology included: Gastrointestinal‐stromal tumor (GIST) (n = 5), Malignant leiomyosarcoma (n = 1), Ectopic pancreas (n = 1), and Foregut duplication cysts (n = 1). All achieved adequate negative surgical margin. Average operation time was 106.14 minutes. [Range, 75–150]. Average length of hospital stay was 3.42 days [range, 1–5]. Complication included one wound infection, and one pyloric stenosis. Average length of follow up was 10.96 months [range, 0.46–31.73]. No recurrence detected and all are still alive till date.Conclusion  Laparoscopic resection of submucosal gastric lesions is a safe and appropriate alternative to open surgery. Its main advantage over open technique includes shorter length of hospital stay, lower recurrence rate and lower mortality rates. Surgical technique depends very much on tumor size and location. Outcome of the patients described from our centre is comparable to the others published till date.
HP11 LYMPH NODE METASTASES AND MICRO‐METASTASES IN SURGERY FOR OESOPHAGEAL CANCER
Authors: Jamieson G. G. 
Published: April 2007

The incidence of lymph node metastases in both squamous cell cancer and adenocarcinoma of the oesophagus increases from about 25% for T1 tumours to 100% for T4 tumours.The absolute number of nodes involved also greatly influences the chance of survival. If no nodes are involved, then cure with oesophagectomy approaches 100%, whilst if more than 10 nodes are involved, cure is close to zero.The introduction of immunohistochemical staining techniques has shown that malignant cells in lymph nodes occur more frequently than previously thought. For instance, figures from seven studies of oesophagectomy and lymphadenectomy for squamous cancer showed that 349 patients were classified histologically as NO, and yet 30% of the patients were shown to have micro‐metastases by immunohistochemical staining. For adenocarcinoma, the figures are eight studies, 353 classified NO and 25% shown to have micro‐metastases in lymph nodes.However, there are difficulties. First, there is no consensus on how many sections to cut for each node, and different studies which have looked at 1 section, 3 sections and 5 sections respectively, have produced quite different results. Second, there is no agreement on what constitutes a micro‐metastasis. It appears that some malignant cells in nodes are actually “in transit” at the time of their removal and may not be metastases at all.Since lymph node status is assuming an ever greater role in the treatment of oesophageal cancer, the necessity for these problems to be resolved is important.
HP12 THE ANATOMICAL BASIS OF THE SURGICAL TREATMENT OF GASTRO‐OESOPHAGEAL REFLUX: LESSONS FROM HISTORY AND SIMULATION
Authors: Windsor J. A. , Yassi R. , Cheng L. , Al‐Ali S. , Le Grice I. , Pullan A. 
Published: April 2007

Purpose  To review the anatomical basis for anti‐reflux operations and describe a project designed to develop a 3D micro‐anatomical model of the gastro‐oesophageal junction with integrated physiological events.Methodology and Results  A realistic 3D anatomically based computer model of the gastro‐oesophageal junction (GOJ) was constructed using cross‐sectional digital images from the Visible Human Project. A finite element mesh was constructed and an iterative fitting process provided smooth surfaces. For accurate simulation of physiologic function it is necessary to augment this geometric model with detailed micro‐structural information. A custom‐built, semi‐automated, extended‐volume imaging system was used to obtain images of the GOJ. The device consists of a three‐axis translation stage where a tissue sample embedded in wax can be sequentially imaged and milled. At each step the top surface was stained for fiber type and connective tissue and the image captured using a high resolution digital camera. Proof of principle was demonstrated with an en‐bloc harvested sheep GOJ and then repeated with a fresh autopsy human GOJ. The 3D microstructural model was constructed using the images with a total volume of 35.1 × 106 voxels. Clinical manometric measurements were used to inform mathematical modeling to simulate physiological events, such as swallowing.Conclusions  This model may provide opportunities to examine the relationship of anatomy and physiology in health and disease of the GOJ, enhance patient education, enable theoretical drug trials and determine the relative importance of anatomical elements of anti‐reflux surgery.
HP19 RE‐OPERATION FOR DYSPHAGIA AFTER CARDIOMYOTOMY FOR ACHALASIA
Authors: Grotenhuis B. A. , Wijnhoven B. P. L. , Myers J. C. , Jamieson G. G. , Devitt P. G. , Watson D. I. 
Published: April 2007

Purpose  Although laparoscopic cardiomyotomy is considered to be the treatment of choice for achalasia, there is no consensus about how persistent or recurrent dysphagia after myotomy should be treated. In this study we evaluated our experience with re‐operation following previous cardiomyotomy.Methodology  From a prospective database, all patients were identified who underwent a re‐cardiomyotomy for persistent or recurrent dysphagia between 1992 and 2006.Results  19 patients (6 female, 13 male) underwent a re‐operation: 7 for persistent and 12 for recurrent dysphagia. The mean time interval between both cardiomyotomies was 81 months. Different operative approaches for reoperations were used, depending on surgeon’s preference and the technique used for the first operation. In 12 patients, the alternative body cavity to that used for the first operation (thoracic versus abdominal) was used for access in the revision operation. This was associated with a shorter operation time (90 vs.128 minutes). An incomplete myotomy or scar tissue were the most common causes of failure identified. Mean hospital stay was 4 days. Mean follow‐up after the revision operation was 3.6 years. 89% of patients had an improvement in symptoms, and the mean satisfaction score (0–10) was 7.Conclusion  Re‐operation for persistent or recurrent achalasia achieves a satisfactory outcome in most patients. Using the alternative body cavity to that used in the original procedure facilitates minimal access techniques, and gives easier access to the operative field.
HP20 OESOPHAGECTOMY FOR TUMOURS AND DYSPLASIA OF THE OESOPHAGUS AND GASTRO‐OESOPHAGEAL JUNCTION: EXPERIENCE OF A SINGLE SURGEON
Authors: Epari K. P. , Cade R. J. 
Published: April 2007

Purpose  Neoadjuvant therapy, radical lymphadenectomy and treatment in high volume centres have been proposed to improve outcomes for resectable oesophageal tumours. The aim of our study was to review the outcomes of oesophagectomy performed by a single surgeon with a moderate caseload where surgery was the principal treatment and a conservative lymphadenectomy was performed and compare them with current literature.Methodology  The study comprises 125 consecutive cases of attempted oesophagectomy performed by a single surgeon (RC) from 1993–2006. Data has been recorded in a prospective database maintained and updated by the surgeon.Results  Endoscopic ultrasound was used in staging 69% of patients. Only 23% patients received neoadjuvant therapy. Resection rate was 97%. There were 121 oesophagectomies performed with a complete R0 resection in 82%. In‐hospital mortality was 0.8%. Clinical anastomotic leak occurred in 1.7%. Median length of stay was 14 days. Overall median and 5 year survival were 46 months and 47%. Stage specific 5 year survival was stage 0 100%, stage I 71%, stage II 41% and stage III 21%. Isolated local recurrence occurred in 8%. Dilatation was required in 15 patients and 3 stents were placed.Conclusion  A moderate volume surgeon with specialist training can achieve a low mortality and anastomotic leak rate with good survival outcomes. Surgery remains the principal treatment for resectable oesophageal tumours. The role for neoadjuvant therapy and radical lymphadenectomy is controversial and remains to be clearly defined. Accurate preoperative staging with endoscopic ultrasound is important for selection of patients, determining therapy and comparison of results.
HP21 ACUTE PRESENTATION OF GASTRIC CANCER IS ASSOCIATED WITH A WORSE PROGNOSIS
Authors: Lo A. S. N. , Bartlett A. , Siu M. , Poole G. 
Published: April 2007

Purpose  Some patients with gastric cancers develop acute complications and present acutely. It has been proposed that this group of patients have a worse prognosis. This paper describes the management of acute and elective gastric cancer patients at South Auckland Health.Methods  Patients were identified by electronic searching patient records from 2000 to 2006, and obtaining data pertaining to patient demographics, mode of presentation, management and outcome.Results  Two‐hundred and thirty eight patients were identified, of which 120 (50%) had an acute presentation. Patient demographics were similar in both groups, except for acute patients were older (77 years compared to 64 years; p < 0.001). Gastrointestinal bleeding and vomiting were more common in patients that presented acutely, 46% and 39% respectively, compared to 19% and 14% respectively in the elective group (p < 0.001). Fifty‐six percent of all patients underwent an operation; 36% had a curative resection, 11% palliative resection and 9% had an operation for the purpose of staging. Curative resection was undertaken more commonly in patients that presented electively (47%) than those that presented acutely (24%; p < 0.001). After curative resections, the median survival for acute patients was 30.3 months, with a 3 year overall survival rate of 41.6%, compared to 72% for elective patients (p < 0.0001).Conclusions  We have shown that 50% of patients with gastric cancer develop complications leading to an acute presentation. Only a minority of these patients are able to undergo resection with a curative intent, and consequently these patients have a poorer survival.
HP23 USE OF ANTI‐REFLUX MEDICATION AFTER ANTI‐REFLUX SURGERY
Authors: Wijnhoven B. P. L. , Lally C. J. , Kelly J. J. , Myers J. C. , Watson D. I. 
Published: April 2007

Purpose  It is thought that a substantial number of patients who undergo anti‐reflux surgery use anti‐reflux medication post operatively, despite no objective evidence of reflux. This study aims to determine the prevalence and underlying reasons for anti‐reflux medication usage in patients after anti‐reflux surgery.Methodology  A questionnaire (13 questions) on the usage of anti‐reflux medication was sent to 1016 patients from a prospective database of anti‐reflux surgery patients.Results  852 patients (84%), (437 males & 415 females with a mean age 58 yrs) returned the questionnaire. Mean follow up was 5.9 yrs after surgery. A single or combination of medications was being taken by 319 patients (37%): 82% proton pump inhibitors, 9% H2‐blockers and 34% antacids. 54 patients (18%) had never stopped taking medication, whereas 261 patients (82%) re‐started medication at a mean of 2.4 yrs after surgery. Persistent or return of the same or different symptoms was the reason for taking medication by the vast majority (85%), whereas 15% were asymptomatic or had other reasons for medication use. A response of symptoms to the medication occurred for 30% of the patients, whereas 64% noticed some improvement. Postoperative 24‐hour pH studies (while off medication) were abnormal in 17/62 patients (27%) on medication and in 5/73 patients (6%) not taking medication.Conclusions  Anti‐reflux medication is frequently taken by patients for symptoms after surgery, despite normal pH profiles in the majority. Strategies need to be employed to lower the inappropriate use of medications after surgery and to further evaluate the mechanisms underlying postoperative symptoms, which are non‐responsive to anti‐reflux medication.
HP25 LAPAROSCOPIC SLEEVE GASTRECTOMY FOR MORBIDLY OBESE PATIENTS
Authors: Ou Yang S. O. , Loi K. , Jorgensen J. , Talbot M. 
Published: April 2007

Background  Obesity surgery is been endorsed as the only effective method of weight reduction in morbidly obese patients. Laparoscopic Roux‐en‐Y gastric bypass (LRYGBP) is been used as the most effective procedures in our centre. However LRYGBP also conveys high risk of peri‐ and postoperative complications on obese patients. Laparoscopic sleeve gastrectomy (LSG) is been employed first‐stage procedure as a risk reduction strategy. The aim of this study was to report the short‐term outcomes of LSG, its effect on risk reduction and resolution in co‐morbidities.Methods  We prospectively investigated 92 patients who underwent LSG between July 2004 and February 2006 and completed our data collection through 3‐ to 6‐monthly follow up and/or patient questionnaire. Data collected included demographics, degree of weight reduction, postoperative complications, and changes in co‐morbidities.Results  Median BMI was 52.03 kg/m2 (33–82). 56% patients had a BMI >50 kg/m2. The median postoperative excess weight loss (EWL) was 45% with 35.49% at 6 months, 49.07% at 12 months, and 55.75% at 18 months. 39% of patients had resolutions in Diabetes Mellitus type 2, 56% had resolutions in dyslipidaemia, 28% in hypertension, 66% in obstructive sleep apnoea. Complication rate of 7.5% and three patients necessitated surgical intervention. There was zero mortality.Conclusion  LSG minimizes postoperative complication rates significantly on high risk patients and achieves effective short‐term weight loss with resolutions in co‐morbidities. Additional studies are required to evaluate LSG as a stand‐lone procedure.