bluuebunny/crossref_metadata_2025_split huggingface dataset:
FIRST AID IN THE AIR
Authors: Donaldson Eric , Pearnt John 
Published: January 2008

Background: First aid is commonly required during commercial aircraft flights, especially during international flights. An intimidating and sometimes threatening array of in‐flight medical emergencies challenge the doctor, flight attendants and other passengers in such medical emergencies. Cramped conditions, difficulties of access to the victim, lack of privacy, cultural and language differences and noise and vibration all compound to increase the difficulties of the normal first aid drills which are required in the management of in‐cabin emergencies. Doctors who fly as passengers are liable to be called upon to render first aid in the air. We provide an analysis of the types of medical emergencies encountered during commercial air travel.Methods: We have reviewed all consecutive in‐flight medical incident reports for QANTAS international flights for 1993. All incidents requiring the attention of a doctor were included.Results: A total of 454 significant medical incidents occurred. These included, in rank order, syncope (35%), angina and cardiac emergencies (23%), gastrointestinal conditions (13%), respiratory tract infections and asthma (9%) and anxiety and panic reactions warranting medical intervention (5%).Conclusions: Syncope, the management of gastrointestinal symptoms and problems of angina comprise over half (58%) of the presenting symptoms which confront a fellow traveller who may coincidentally be a medical practitioner. Problems of anxiety, sleeplessness, airport bustle, immobility, barotrauma, alcohol abuse and mild hypoxia are discussed in the context of precipitating factors which may trigger an in‐flight emergency. Psychological problems are very common and challenge the first aider, whether or not he or she is medically trained. We emphasize the necessity for doctors and nurses to be trained in first aid, as a distinct profession in its own right and a series of drills and skills which are distinctive from those of surgery‐based health care. The 5% annual increase in air‐passenger traffic, predicted for the next two decades, highlights the importance of special training for ‘first aid in the air’.
PAEDIATRIC RENAL TRAUMA: CAUTION WITH CONSERVATIVE MANAGEMENT OF MAJOR INJURIES
Authors: Thompson‐Fawcett Mark , Kolbe Anne 
Published: January 2008

Background: The kidney is the most frequently injured abdominal organ in children and controversy surrounds some aspects of management. This study looks at the experience of our institution and reviews the literature towards developing an optimal strategy for managing this common childhood injury.Methods: One hundred and forty‐two cases of paediatric renal trauma are reported from a catchment population of approximately 240 000 children < 14 years of age over a 12 year period. Injuries were classified into four groups: groups 1 and 2 were regarded as minor injuries (85%) and group 3 and 4 injuries were those with extravasation of urine or pedicle injury (15%). Results: The male:female ratio was 2:I with an average age of 8.5 years. Major renal injuries frequently required large amounts of resuscitation fluid. Associated injuries were present in 41% of all cases with an average of two injuries each. With one exception in each case, the development of complications and the need for early surgery were confined to major injuries. There were no long‐term complications. The renal loss rate was 2.1%.Conclusions: Renal injuries can be usefully classified into major or minor by determining whether extravasation of urine or pedicle injury is present. Minor injuries should be managed conservatively. Major injuries causing ongoing haemorrhage require urgent surgery. Other major injuries should be imaged regularly and patients with more severe urinomas benefit from early elective surgery at 2–5 days. In cases where extravasation of urine has not shown clear evidence of settling by 5 days' elective surgery probably results in less morbidity and fewer complications than protracted conservative treatment.
BONE REPLACEMENT IN HEAD AND NECK SURGERY: A BIOCOMPATIBLE ALTERNATIVE
Authors: Cole Ian , Dan Noel , Anker Anthony 
Published: January 2008

Background: Defects in the skull have presented difficult reconstructive problems. Recently glass‐ionomer cement and preformed implants have been used to repair bony defects in the skull base and in cranio‐facial surgery. Three patients are reported to illustrate possible applications for this new material. Methods: Ionocap cement and Ionoroc‐skull standardized implants have been used. The cement is available as a two component blister pack. When mixed and blended a gel is produced which can be worked for approximately 5 min before hardening. It can then be contoured and drilled to the required shape. The resultant material is biocompatible and biostable, is non‐toxic and permanently bonds to bone with no increase in temperature or shrinkage. Results: The material has been used to fill the temporal defect left by transplantation of the temporalis muscle for oral reconstruction, the anterior and lateral walls of the maxilla and following craniofacial resection, the posterior wall of the frontal sinus and anterior skull base. Conclusions: Three patients with different reconstructive problems have been presented to illustrate the use of an alloplastic material that has a tensile strength similar to bone* and firmly adheres to it. The material was found to be safe and easy to use. All three patients have now been followed for 12 months with no adverse affects.
PRECLINICAL TRIAL OF A BlOARTlFlClAL LIVER SUPPORT SYSTEM IN A PORCINE FULMINANT HEPATIC FAILURE MODEL
Authors: Sheil A. G. R. , Sun J. , Mears D. C. , Warin M. , Woodman K. , Johnston B. , Horvat M. , Watson K. J. , Koutalistras N. , Wang L‐S. 
Published: January 2008

Background: This study describes the pre‐clinical trials of an extracorporeal bioartificial liver support system (BALSS). It includes the biochemical changes which occur in the plasma and blood of pigs with devascularized livers when the plasma is treated in a BALSS, and the testing of the system for presence or absence of infective agents, pyrogens and for toxicity.Methods: Hepatic cells were prepared from littermate juvenile white landrace pigs with a double‐step collagenase digest technique. The cell preparations were incubated with collagen‐coated dextran microspheres (CDM) for 3 h and the medium was tested to determine cellular metabolic activity. Incubation continued for a further 20 h during which the hepatic cells attach to the CDM. The CDM‐attached cells were inoculated into a hollow fibre bioreactor which was part of an extracorporeal liver support system.Results: Hepatic cell content of the bioreactor was 6 × 109± 3 × 1018 cells, equivalent to those present in half a pig's liver. The system was tested in a controlled trial with the plasma of pigs with fulminant hepatic failure (FHF) due to devascularized livers. When plasma from FHF pigs was circulated through the device there was significantly less of an increase in the accumulation of ammonia, lactate and most amino acids when hepatic cells were included in the circuit compared with those in control experiments when they were excluded. Similar changes occurred in porcine blood. There were few infections diagnosed and an absence of pyrogens, endotoxins and toxicity in the bioreactor contents or in the terminating reservoir or animal blood samples.Conclusions: We believe that the results, demonstrating function of the porcine hepatic cells in the circuit, together with low risks, justify a clinical trial of use of the BALSS in Australia.
STEREOTACTIC 14 GAUGE CORE‐BIOPSY OF THE BREAST: RESULTS FROM 101 PATIENTS
Authors: Frayne J. , Sterrett G. F. , Harvey J. , Goodwin P. , Townsend J. , Ingram D. , Parsons R. W. 
Published: January 2008

Background: Along with fine needle aspiration (FNA) cytology, core‐biopsy has become an integral part of the assessment of mammographically detected breast lesions.Methods: A series of stereotactic large‐core‐biopsies of mammographically detected breast lesions was studied to assess the accuracy and limitations of the technique in diagnosing malignancy and in giving specific benign diagnoses, and its use in determining surgical management.Results: Eighty per cent of carcinomas were diagnosed as malignant (absolute sensitivity). In 88.8% of the cancers, the core‐biopsy was classified as malignant, suspicious or atypical/indeterminate (complete sensitivity), and in 72% of the invasive carcinomas, invasive tumour was present in the core. The technique was more successful for invasive carcinomas than for ductal carcinoma in situ (DCIS) (absolute sensitivity 86.1 and 55.5, respectively; P= 0.28) and for malignant mass lesions than for a mass with associated microcalcifications or for pure microcalcifications (absolute sensitivity 91, 71 and 66.6%, respectively; P= 0.19). In five of the 45 cancers (11.1%), no tumour tissue was present in the core, but all were excised after mammographic review and no delays in diagnosis have been experienced to date. The benign to malignant ratio for excised lesions was 0.11:1. Of the benign lesions, a specific diagnosis was given in 49% (calcifications in the core in a background of fibrocystic change, or postoperative scarring, or fibro‐adenoma); the remainder showed non‐specific benign findings. All patients where invasive carcinoma was diagnosed in the core underwent axillary clearance and wide local excision or mastectomy at their first operation.Conclusions: This technique can markedly reduce the number of benign lesions needing open biopsy, and provide information allowing definitive management of most carcinomas at the first operation. The accuracy of core‐biopsy was lower in DCIS/ microcalcification lesions; extra core samples or a combination of FNA and core‐biopsy may be of value in these cases.
THE MANAGEMENT OF LEFT‐SIDED LARGE BOWEL OBSTRUCTION: AN AUDIT
Authors: Isbister W. H. , Prasad J. 
Published: January 2008

Background: The outcomes of patients admitted acutely to hospital with left‐sided large bowel obstruction (LBO) were examined.Methods: All patients admitted to the colorectal service (University Department of Surgery, Wellington School of Medicine) with LBO between 1975 and 1990 were reviewed. Sixty‐four patients with left‐sided LBO were identified.Results: The most commonly found obstructing lesion was cancer. Two patients were not managed surgically. In 17.7% of patients there was development of postoperative respiratory complications and 16% developed wound problems following primary surgery. Fifty‐nine patients survived their primary surgery and 45 had stomas. The stoma closure rate was 71.1% (32 of 45). The overall mortality rate for patients managed surgically was 6.5% (four of 62). The mortality rate for stoma formation was 4.3% (two of 47). The mortality rate for resection and then stoma closure was 3.2% (one of 32).Conclusions: This study has shown that a staged approach to the management of unselected patients with left‐sided LBO is safe. Restoration of bowel continuity was achieved in 70% of patients.
LYMPHOVASCULAR CLEARANCE IN LAPAROSCOPICALLY ASSISTED RIGHT HEMICOLECTOMY IS SIMILAR TO OPEN SURGERY
Authors: Moore J. W. E. , Bokey E. L. , Newland R. C. , Chapuis P. H. 
Published: January 2008

Background: The application of laparoscopic techniques to malignant colorectal disease has led to concerns regarding the adequacy of excision achieved. This study was performed to compare specimen histopathology following laparoscopically assisted right hemicolectomy (LARHC) with that following open right hemicolectomy (ORHC).Methods: Data regarding patient details and tumour pathology were obtained by case‐note review and from the Concord Hospital Colorectal Cancer Database. Thirty‐two patients had LARHC for neoplastic lesions and 34 had ORHC for similar lesions over the same period. The two groups were well matched with respect to age, sex, weight and tumour characteristics. Early stage disease was more common in the LARHC group.Results: There was no clinically significant difference between the groups in terms of margins of clearance or number of lymph nodes harvested.Conclusions: LARHC allows lymphovascular clearance indistinguishable from that afforded by open surgery. Long‐term outcome and survival data are required to confirm its role in the treatment of malignant colorectal disease.
INTERNAL PANCREATIC FISTULAE WITH SEROUS EFFUSIONS IN CHRONIC PANCREATITIS
Authors: Dhar Puneet , Tomey Sudhir , Jain Pradeep , Azfar Mohammed , Sachdev Ajay , Chaudhary Adarsh 
Published: January 2008

Background: Serous effusions in chronic pancreatitis are infrequent but persistent. These occur usually as a consequence of internal pancreatic fistulae and commonly involve the pleural cavity or peritoneum.Methods: To assess strategies in operative management, the records of 12 patients who underwent surgery for internal pancreatic fistula with underlying chronic pancreatitis were reviewed retrospectively. Seven patients had pancreatic ductal calculi. Three cases underwent external drainage. Three cases with leaking pseudocysts underwent cystojejunostomy‐en‐Y. Three cases with ductal dilatation or calculi underwent lateral pancreaticojejunostomy and three patients had caudal pancreatectomy for distal disease.Results: Eight patients were completely controlled of all symptoms, with no sequelae. One case each had recurrent pancreatitis and ascites but did not require re‐operation. There were two deaths: one with massive haematemesis and one with pre‐existent multi‐organ failure and sepsis.Conclusions: Pancreatic duct stones may be causally associated with internal pancreatic fistulae. Delineation of ductal anatomy and pathological aberrations of the pancreas, including determination of the leak site, was of paramount importance in planning surgery. Peroperative ductography proved the most useful in this regard.
THE PORTRAYAL OF THE DOCTOR IN NON‐MEDICAL LITERATURE 15. THE SURGEON
Authors: Posen Solomon 
Published: January 2008

Fictional surgeons are perceived as confident and competent individuals. They may not have a profound knowledge of basic physiology or statistical methods and their social behavior may lack refinement, but they are great technologists and most of their patients get better. Inside the operating room, surgeons are absolute autocrats, with a few abusing their position and turning into petty tyrants.The prominent status of fictional surgeons within the medical profession is reflected in their arrogant and patronizing attitudes towards patients, primary care doctors and non‐surgical specialists.Fictional surgeons are impatient, irascible and aggressive. These traits make them poor communicators and teachers. A few are suspected of harbouring sadistic tendencies. On the other hand, when the surgeon turns his aggression towards the disease process rather than his colleagues or his trainees, it enables him to achieve some spectacular therapeutic successes.
HYPERPARATHYROIDISM PRESENTING AS PANCREATITIS OR COMPLICATED BY POSTOPERATIVE PANCREATITIS
Authors: Shepherd J. J. 
Published: January 2008

Background: The association of hyperparathyroidism with acute pancreatitis either pre‐operatively or postoperatively has been questioned in recent overseas literature.Methods: A review of medical records and histology reports in the Royal Hobart Hospital from 1971 to 1993 was carried out to identify all cases of acute pancreatitis associated with primary hyperparathyroidism.Results: Seven cases are presented, six with histological confirmation, of hyperparathyroidism associated with pancreatitis in a period when 137 confirmed cases of primary hyperparathyroidism were treated. None of these patients had gallstones. In two, alcohol abuse may have been the aetiological factor. Five patients had successful neck exploration and none of them have experienced any further attacks including a 25 year old who had four hospitalizations and one laparotomy for pancreatitis in the year before parathyroidectomy 12 years ago. Two patients died from acute pancreatitis, one without exploration and the other with a mediastinal parathyroid adenoma that was not located at surgery.Conclusions: Most parathyroid surgeons would proceed to mediastinotomy, if necessary, at initial exploration in a patient with previous hypercalcaemic crisis. This should also be considered in patients with a history of acute pancreatitis.
CHANGES IN FIBRINOGEN LEVELS IN PATIENTS UNDERGOING OPEN AND LAPAROSCOPIC NISSEN FUNDOPLICATION
Authors: Pike Gregory K. , Bessell Justin R. , Mathew George , Watson David I. , Mitchell Phillip C. , Jamieson Glyn G. 
Published: January 2008

Background: Venous thromboembolic complications may be more common after laparoscopic surgical techniques, possibly due to changes in venous flow and blood coagulability.Methods: This study assessed fibrinogen, cross‐linked fibrin degradation products (D‐dimer), prothrombin international normalized ratio (INR), activated partial thromboplastin time (APTT) and platelets, during and after both open and laparoscopic Nissen fundoplication to determine whether coagulability is increased by the laparoscopic approach.Results: Seven patients underwent open and thirteen underwent laparoscopic Nissen fundoplication. Fibrinogen levels following open fundoplication fell from 2.8 ± 0.3 g/L pre‐operatively to 2.0 ± 0.3 g/L following skin incision, and then increased to 4.1 ± 0.4 g/L on the first postoperative day. Similar changes in fibrinogen occurred following laparoscopic fundoplication (2.7 ± 0.2, 2.5 ± 0.2 and 3.8 ± 0.4 g/L, respectively). No significant changes in the other coagulation indices were observed.Conclusions: These results demonstrate hypercoagulability on the first postoperative day, irrespective of the operative technique. No differences between the results following laparoscopic and open fundoplication were demonstrated.
A PROPOSED MODEL FOR THE MOVEMENT OF CELLS WITHIN THE |ABDOMINAL CAVITY DURING CO2 INSUFFLATION AND LAPAROSCOPY
Authors: Thomas W. M. , Eaton M. C. , Hewett P. J. 
Published: January 2008

Background: The application of laparoscopic‐assisted surgery to gastrointestinal malignancy has lead to the recurrence of malignancy in wounds created during these procedures by laparoscopic ports.Methods: Possible mechanisms of this complication have been studied in an in vitro model. Using filter systems, we have examined the expelled carbon dioxide used during laparoscopy and the laparoscopic ports and instruments for the presence of malignant cells.Results: No malignant cells were identified in the exhaust CO2 examined, whereas all instruments and laparoscopic ports were contaminated by malignant cells.Conclusions: These findings suggest that direct contamination by the instruments and ports and not dispersion of malignant cells by CO2 is the route by which port seeding of tumour cells occurs.
PARAFFINOMAS OF THE BREAST: AN ORIENTAL CURIOSITY
Authors: Alagaratnam Thevakaruna T. , Ng Wing F. 
Published: January 2008

Background: The injection of liquid paraffin wax was a form of breast augmentation practised in Hong Kong 30–40 years ago. Patients may present many years later with complications of this treatment.Methods: The records of 43 patients diagnosed with paraffinomas of the breast at a teaching hospital in Hong Kong were reviewed. These patients had received paraffin injections 3–41 years (median 17) previously.Results: Patients presented with hard masses in the breast 4–18 cm (median 17) diameter. Ulceration or infection occurred in 10 patients. Mammography revealed a honeycomb appearance in the affected breast. Treatment included biopsy only (7), excision of masses (3) and total mastectomy (30, bilateral in 27). Histology demonstrated hyalinized and densely sclerotic fibrous tissue with cystic spaces of various sizes.Conclusions: Awareness of this condition facilitates the differentiation from tuberculosis and carcinoma of the breast which often present late in this population of patients. Adequate treatment usually requires total mastectomy.
THE PREVALENCE OF MEN‐I IN TASMANIA
Authors: Wilkinson S. , Young M. , Shepherd J. J. 
Published: January 2008

Background: An extensive programme was undertaken to trace and screen four known families in Tasmania with multiple endocrine neoplasia type 1 (MEN‐I).Methods: Written and personal contact was made with family members over the age of 20 years recommending a review by family practitioners for the purpose of recording their medical history and collecting a blood sample. Those suspected of MEN‐1 were referred to our Department for further investigation.Results: In January 1993, the total number of individuals alive and known to be affected by MEN‐I was 107, giving a prevalence of MEN‐I disease in Tasmania of 23/100 000. The estimated prevalence of the MEN‐I trait in Tasmania (including affected cases and those considered at 50% risk of possessing the trait) is 45/100 000.Conclusion: The prevalence of MEN‐I has never previously been determined accurately. The prevalence of MEN‐I in Tasmania is at the upper end of the possible range and would justify the allocation of resources for screening programmes equal to those available for the detection of several less prevalent genetic diseases.
OPTIMIZING THE HOSPITAL MANAGEMENT OF LEG ULCERS
Authors: Gruen Russell L. , Chang Stanley , MacLellan Donald G. 
Published: January 2008

Background: Leg ulcers are common and are often the cause of a long hospital admission. However, little information is available on the efficacy and efficiency of inpatient leg ulcer management. The inpatient management of leg ulceration was examined and areas for improvement were sought.Methods: The management of patients admitted to a teaching hospital with a primary diagnosis of leg ulceration was examined, the costs estimated and areas for improvement identified. A retrospective analysis of 174 admissions to Heidelberg Repatriation Hospital between I January 1991 and 31 December 1992 was performed.Results: Of 119 patients, 61 had ulcers due to arterial disease and 34 due to venous disease. Over 2 years, leg ulcers accounted for 5259 inpatient bed days, a mean of 44.2 days per patient. The estimated cost exceeded $2 750 000, averaging over $12 000 per admission. Thirty‐three percent of patients had no recorded investigations into the cause of their ulcer and fewer than 50% had documented improvement at discharge.Conclusions: Leg ulcers are costly due to their extended treatment on an inpatient basis. Unfortunately, hospital admission does not guarantee optimal wound healing rates. A leg ulcer protocol is proposed to minimize inpatient stay and improve investigation and management in an outpatient or community setting.
TREATMENT PRINCIPLES IN ADVANCED COLORECTAL CANCER
Authors: Zalcberg J. R. , Friedlander M. L. , Collopy B. T. , Barton M. , Gray B. 
Published: January 2008

Background: Colorectal cancer is an important disease in the Australian community. Whilst there has been much discussion about the appropriate management of local disease, particularly with respect to the issue of adjuvant therapy, there has been relatively little local discussion of treatment options in metastatic colorectal cancer.Methods: The critical principles underlying treatment in this setting are briefly outlined in the present article, indicating wherever possible what options could be considered standard, and based on the available literature, which approaches must still be considered experimental at this time.Results: Overall, the results of treatment in this group of patients remain poor.Conclusion: Further clinical trials are required to address the issues affecting patients with metastatic colorectal cancer.