bluuebunny/crossref_metadata_2025_split huggingface dataset:
GS16P BEST PRACTICE FOR ASSESSMENT OF VARICOSE VEINS
Authors: Horrocks E. , Roake J. A. , Lewis D. R. 
Published: April 2007

Purpose  Varicose veins are a significant health problem which attract much medico‐legal attention. Recent publications have suggested “best practice” regarding assessment of patients with varicose veins. A retrospective audit was performed comparing clinical practice in a New Zealand teaching hospital with suggested standards.Methods  Clinic letters from 80 patients awaiting varicose vein surgery were reviewed. Data were collated regarding presenting problem, relevant medical history, clinical findings on examination, further investigations and outcome.Results  Presenting complaint was noted for 99% of patients but actual symptoms were only recorded for 41%. The degree of disability caused by varicose veins was documented for 33% and patient concerns in 4%. Half of the patients presented with leg ulcers but ABPIs were only recorded in 26% of clinic letters. Duplex scanning was recommended prior to surgery for 69% of patients and hand held Doppler assessment of venous disease was recorded in 61% cases. Clinic letters did not specify the nature and extent of disease in 6% of cases, and although every patient was recommended for surgery the exact procedure was specified in only 24%. Details of surgical risks and complications were only present in 20% of letters, and only 21% of patients received a printed information sheet.Conclusions  The quality of the data recorded in the clinic letters of fell below suggested standards for assessment of patients with varicose veins. Improving the documentation of patient assessment will allow better communication between providers of healthcare and make clinical errors less likely.
GS22P PROTOCOLS FOR MANAGEMENT OF BOWEL OBSTRUCTION MAY NOT IMPROVE PATIENT OUTCOMES
Authors: Mignanelli E. , Skinner S. 
Published: April 2007

Purpose  Bowel obstruction is a common surgical presentation, but has no defined management protocol. Our aim was to devise a series of protocols for small bowel obstruction (SBO) and large bowel obstruction (LBO) and determine if protocol implementation affects patient outcomes.Methods  This prospective single‐blinded study involved an initial Medline literature review to develop “ideal management protocols” for both SBO and LBO. Patients with bowel obstruction were identified at admission and assigned to a treatment protocol. Treating clinicians were blinded to the protocols and managed patients as they normally would. Patients were followed prospectively with investigations and management compared to “ideal management protocol”. Results were evaluated using Students’ T‐Test and T test.Results  Sixty consecutive patients were identified. The use of nasogastric tubes (65%) was lower than expected from the “ideal protocol”, but their use did not significantly impact on time to first bowel action (p = 0.48), length of stay (p = 0.19), time to surgery (p = 0.16). Urinary catheters were used in 70% of patients, but had no significant impact on renal function (p = 0.27). In adhesive SBO, Gastrograffin follow – through was used in 61.5% of cases, but did not impact on time to first bowel action (p = 0.13), length of stay (p = 0.08), time to surgery (p = 0.48). In LBO contrast enema was performed in only 30.1% of cases, but there was no significant delay in surgery (p = 0.98).Conclusion  Current management of SBO and LBO varied widely from the “ideal management protocol”, yet patients managed outside the protocols showed no significant differences in overall outcomes.
GS30P YOUNGER PATIENTS ARE MORE LIKELY TO SUFFER POST‐CHOLECYSTECTOMY DIARRHOEA
Authors: Fisher M. , Tong L. K. , Spilias D. C. 
Published: April 2007

Purpose  Fatty food intolerance and diarrhoea (PCD) are increasingly being recognised as distressing postoperative sequels in a proportion of patients undergoing laparoscopic cholecystectomy. Understanding of PCD, its predisposing factors and associated symptoms is important for both consent and postoperative management.Methodology  100 consecutive patients underwent chart review and telephone contact. A standardised questionnaire was used to collect data on age; sex; weight/BMI; pre‐ and post‐operative bowel habits, bloating, pain, dietary intolerance, dietary modification and patient satisfaction. Patients were divided into two categories, those with and those without PCD. Groups were compared using t‐test and univariate analysis to determine significance at p‐value of 0.05.Results  Two patients were excluded due to preoperative diarrhoea (2%). PCD, defined by changes in consistency and frequency of bowel actions (p = 0.0004), was observed in 17 of 98 patients (17%). PCD was associated with younger age (p = 0.014), higher weight (p = 0.041), less bloating preoperatively (p = 0.045) and higher likelihood of bloating postoperatively (p = 0.048). There was no statistically significant correlation with dietary intolerance, dietary modification or patient satisfaction. 7 patients (7%) reported postoperative constipation or resolution of pre‐existing diarrhoea.Conclusions  Subjective PCD and dyspeptic symptoms correlate with measurable differences in bowel habits. Younger patients are significantly more likely to develop PCD and should specifically be warned of this possibility.
HS02 BOTULINUM TOXIN A IN OBSTETRIC BRACHIAL PLEXUS PALSY
Authors: Johnstone B. R. , McCombe D. , Coombs C. , Britt K. 
Published: April 2007

Purpose  To evaluate children with obstetric brachial plexus palsy treated with botulinum toxin A (Botox)injections to assist with the management of contracted muscles and joints as well as co‐contraction.Methods  Since September 2004, 20 children have been treated. The median age at treatment was 2.1 years (range 7 months to 11 years). As experience was gained, the total dose of Botox increased from 4 to 10 units per kg.Results  12 patients were treated primarily for restriction of passive external rotation at the shoulder at an average age of 24 months (range 7 to 42 months). This group had the most impressive gains which became apparent within a week of injection. There was a high level of parental satisfaction with an improvement in passive range and increased ease of physiotherapy. Six had excellent and 4 had good results. The two patients who had little improvement had clear indications for surgery. Seven (58%) of these 12 patients went on to have a repeat injection , in 2 cases with a higher dose, aiming to achieve further gains. Five patients were treated for co‐contraction of the latissimus dorsi and/or teres major were aged 8 months and from 8 to 11 years. They reported minor gains.All five patients who had triceps injections had improved elbow flexion.One patient had an over active biceps injected with minor benefit.Conclusion  It is hoped that persistent physiotherapy assisted by botulinum toxin A injections targeting internal rotators can reduce gleno‐humoral joint dysplasia, posterior subluxation and the need for open procedures. Shoulder subluxation identified by ultrasound should be further imaged with CT or MRI and be considered for an open procedure.
HS05 CRPS – CURRENT IDEAS ON MANAGEMENT
Authors: Shipton E. A. 
Published: April 2007

Complex regional pain syndrome (CRPS) is characterised by extreme pain and dysfunction of the sympathetic nervous system in one region of the body, usually an extremity.(1) It involves the somatosensory, sympathetic and the somato‐motor systems. It consists of local neurogenic inflammation out of proportion to injury; severe pain in the skin, subcutaneous tissues and joints; and central hyperexcitability that is often compounded with a sympathetic component. It is multifaceted manifesting both central and peripheral neurologic pathophysiology, including a prominent psychosocial component.Mechanisms include trauma related cytokine release, exaggerated neurogenic inflammation, sympathetic afferent coupling, adrenoreceptor pathology, glial cell activation and cortical reorganisation.(2)Diagnostic criteria and tests used will be discussed. Biomedical interventions include the use of primary and secondary analgesics, neural blockade, sympatholysis, ketamine, bisphosphonates, and spinal cord/peripheral nerve stimulation. Psychological and behavioural factors can exacerbate the pain and dysfunction associated with CRPS.(3) Mirror visual feedback was introduced recently for rehabilitation but needs to be evaluated in randomized controlled trials.(4)
HP01 METALS IN GALLBLADDER CARCINOGENESIS
Authors:   Puneet, Singh M. , Singh S. P. , Shukla V. K. 
Published: April 2007

Carcinoma gallbladder is the commonest malignancy in the Northern part of India. The heavy metals are known carcinogens while trace metals have protective effect.Aim  The aim of the study is to estimate the heavy and trace metal (Lead, Zinc, Copper, Cadmium, Chromium, Manganese and Selenium) concentration in serum, bile, tissue and gallstone in patients with gallbladder diseases.Method  This is a pilot study conducted in 45 cases (Group – I: 15 cases of carcinoma gallbladder, Group II: 15 patients of cholecystitis with cholelithiasis and Group – III: 15 patients of healthy control), to detect the relationship between the heavy and trace metal concentration and gall bladder carcinoma. Analysis of metal was done using Perkins‐Elmer model 2380 atomic absorption spectrophotometer.Results  The serum concentration of copper and nickel was significantly high in carcinoma gallbladder patients as compared to patients with cholecystitis while zinc and selenium is low in carcinoma gallbladder patients. Bile concentration of zinc, selenium and manganese was significantly low in carcinoma gallbladder patients (p < 0.05) as compared to patients of cholelithiasis while cadmium and nickel was high. Tissue concentration of manganese was significantly low in carcinoma gallbladder patients as compared to patients of cholelithiasis while chromium was high. Gallstone concentration of copper, manganese and lead was significantly low in carcinoma gallbladder patients as compared to patients of cholelithiasis.Conclusion  The heavy metals are in higher concentration in carcinoma gallbladder while trace metals are in lower concentration indicating possible role of heavy metal in gallbladder carcinogenesis.
HP14 DETERMINING THE MANOMETRIC AND ANATOMIC FEATURES WHICH INFLUENCE DISTAL OESOPHAGEAL RAMP PRESSURE
Authors: Myers J. C. , Jamieson G. G. 
Published: April 2007

Purpose  Distal oesophageal ramp pressure upon swallowing results from resistance from the oesophago‐gastric junction below and pressure from above (peristaltic wave) with pressure build‐up in the distal oesophagus. Ramps are observed during manometry, but the factors which influence the magnitude of ramp pressure have not been elucidated. This study aims to establish the normal range for ramp pressures and ascertain manometric and anatomic features which affect ramp pressure, in order to study ramp pressures and dysphagia following antireflux surgery.Methodology  A standard 8 channel motility catheter with a sleeve was used with a water perfused manometry system, to record the ramps at 3 cm above the lower oesophageal sphincter (LOS) associated with ten 5 mL water swallows.Results  614 water swallows (5 mL) have been analysed in 68 subjects: 20 controls, 25 reflux patients and 23 patients after a partial (12) or total (11) fundoplication. Control patients had LOS of 17 ± 0.4 mmHg, relaxation pressure of 1.4 ± 0.2 mmHg and a ramp of 8 ± 0.3 mmHg (mean ± std error). Reflux patients had significantly lower pressures than controls for all parameters studied. As expected after anti‐reflux surgery, all pressures were significantly higher with total fundoplication producing the highest pressures. The ramp pressure after total fundoplication was 22 ± 0.6 mmHg and after partial fundoplication was 15 ± 0.5 mmHg.Conclusions  Ramp pressure integrates the distal peristaltic amplitude with lower oesophageal resistance to outflow. It is possible that lower rates of dysphagia after partial fundoplication are associated with lower ramp pressures. However the relationship between ramp pressure and dysphagia remains to be elucidated.
HP02 A MULTICENTRE CONTROLLED STUDY OF INLINE RADIO‐FREQUENCY ABLATION DEVICE FOR LIVER TRANSECTION
Authors: Yao P. , Chu F. , Schilling M. , Zuckerman R. , Marchi J. , Morris D. L. 
Published: April 2007

Purpose  Intraoperative blood loss during liver resection remains a major concern due to association with higher postoperative complications. The InLine RFA device (ILRFA) (Resect Medical Inc® Fremont CA) has achieved promising results in liver surgery with minimal blood loss and no increase of postoperative complications. In this multicentre controlled study, 108 patients undergoing liver resection were investigated.Methodology  108 liver resections were performed in 4 medical centres, consisting of 54 ILRFA and 54 ultrasonic Surgical Aspirator (USA) transection as the control group. Pringle manoeuvre was applied only when required. Blood loss was measured from sponge weights and suction bottle contents.Results  The type of liver resection was very similar in both groups. Median number of RFA deployments was 3 (1–12) with a median coagulation time of 9 (3–36) minutes. Median operation blood loss was 165 ± 20 ml (5–675 ml) in the ILRFA and 654 +/−83 ml (80–3600 ml) in the control, a 74.8% reduction (P < 0.001). The median transection blood loss per unit resection area was 3.29 ± 0.40 (0.14–12.33) ml/cm2 in the ILRFA patients compared with 6.41 ± 0.71 (0.92–36) ml/cm2 in controls, the reduction was 48.7% (P < 0.001). The transection time in ILRFA was slightly faster than that in controls, but not significantly different.Conclusion  ILRFA precoagulation is a safe, effective technique for liver resections which significantly reduces blood loss.
HP28P METANALYSIS OF RECURRENCE AFTER LAPAROSCOPIC REPAIR OF PARAESOPHAGEAL HERNIA
Authors: Rathore M. A. , Najfi S. M. , Mc Muray A. H. 
Published: April 2007

Introduction  Recurrence & reflux are two most important remote complications of lap‐PEH repair (concluded by us at a previous USG meeting UK). However the extent of recurrence remains unknown.Aim  To determine the true incidence of recurrence of recurrence after lap‐PEH repair.Material & methods  A metanalysis was performed. PubMed, Embase, hand search and personal communication were used to access and appraise studies. Inclusion criteria were full‐text papers from 1991 to date describing lap‐PEH repair on >25 pts, at least 6 m follow up and addressing recurrence. ‘Wrap migration’ papers were excluded. Papers were appraised and data was isolated on summary sheets. MS Office Excel 2005 was used to plot results and represented in graphs. Statistics involved calculating odds, 95 ci and alternative scenario.Results  15 studies were eligible (all retrospective). A total of 1132 pts with 100 recurrences were noted. Overall rec rate (in all pts) was 8.8% and was 10.4% if only followed‐up patients (n = 748/1132) were considered. When patients with objective evidence (follow‐up Ba esophagogram) were used (301/1132), ‘true’ rec rate was 25.5% (i.e. 1 in 4 repairs recurred). Learning curve did not appear to be an issue. The studies revealed broad 95 ci and touching the line‐of‐no‐effect thereby increasing the ‘chance factor’. When alternative model was applied, esophageal lengthening (by Collis‐Nissen gastroplasty) revealed a significant protective influence.Conclusion  The true incidence of lap‐PEH recurrence is 25.5%. Mandatory (protocol) follow‐up esophagograms at 1 y are essential. Subconsciously, two emphasis points in the repair have emerged – hiatoplasty and (superadded) esophageal lengthening.
HP34P EXTRANODAL MARGINAL ZONE B‐CELL LYMPHOMA OF MUCOSA ASSOCIATED LYMPHOID TISSUE (MALT) TYPE OF THE GALLBLADDER
Authors: Ng S. K. , Epair K. , Parsons S. , Wei A. , Banting S. W. 
Published: April 2007

Purpose  Extranodal marginal zone B‐cell lymphoma of mucosa associated lymphoid tissue (MALT) type of the gallbladder is rare. We described a case of MALT lymphoma of the gallbladder with splenic and pulmonary dissemination, followed by a review of similar cases reported in English literature.Background  A 60 year old woman presented to our surgical unit with abnormal liver function tests and gallbladder thickening on ultrasonography. Cholecystectomy revealed a chronically inflamed gallbladder with multiple gallstones. Histology showed abnormal sheets of small B lymphoid cells which were CD 20 positive, consistent with a diagnosis of MALT lymphoma. Staging CT showed bilateral pulmonary nodules and mild splenomegaly. PET scan demonstrated increase uptake in lung fields and normal uptake in spleen, bone marrow and lymph node. Bone marrow examination was negative. Final diagnosis is Stage 4 extranodal MALT. She remained in remission on three‐month review. No additional chemotherapy or radiotherapy was administered.Discussion  Extranodal MALT lymphoma of the gallbladder has similar epidemiological features with other extranodal MALT lymphomas. Most patients present with symptoms consistent with cholecystitis. As the gallbladder does not normally contain lymphocytes, persistent lymphoid proliferation due to chronic inflammation may represent a critical step in the development and progression of MALT lymphoma (1). Cholecystectomy without adjuvant therapy is appropriate first line treatment if there is no other symptomatic disease (2). Long term surveillance for relapse and second lymphoma should be considered.
PS10 PHAEOCHROMOCYTOMA IN CHILDREN
Authors: Glengarry J. M. , Hamill J 
Published: April 2007

Purpose  Phaeochromocytomas are rare tumours of the sympathoadrenal neuroendocrine system. It is known that these tumours are associated with Von Hippel Lindau (VHL) disease, multiple endocrine neoplasia type II and neurofibromatosis type I. Recently an association with succinate dehydrogenase type B and D gene mutations has been described. Discovery of a SDHB mutation in a girl at our hospital prompted us to review our experience with phaeochromocytoma in children.Methodology  Retrospective review of case notes of all children treated for phaeochromocytoma over the period 1997–2006 at Starship Children’s Hospital, NZ.Results  Seven patients with 8 tumours were identified with average age of 10 years and average systolic BP of 161. The tumours were adrenal in location in 37.5% and 62.5% extra‐adrenal. Our malignancy rate was 12.5%. Familial disease was noted in two patients with one girl having VHL disease and the other found to carry a mutation in the SDHB gene. All children received preop antihypertensives and were treated operatively with seven open resections and one laparoscopic converted to open resection. One child received adjuvant radiotherapy. There were no recurrences or deaths.Conclusions  Phaeochromocytoma in children varies from the adult form. It is more likely to be extra‐adrenal and have a greater chance of a familial genetic syndrome. The discovery of SDH mutations has altered the diagnosis of familial disease and carries implications for family screening, prognosis and surveillance. We emphasize the importance of taking a good family history and suggest screening for SDH mutations in all patients with phaeochromocytoma.
PR15 THE BRANCHING PATTERN OF THE DIEA FOR PERFORATOR FLAPS: THE IMPORTANCE OF PREOPERATIVE CT ANGIOGRAPHY
Authors: Rozen W. M. , Phillips T. J. , Ashton M. W. , Stella D. L. , Taylor G. I. 
Published: April 2007

Purpose  Abdominal donor site flaps are the standard in autologous breast reconstruction. With significant variation in the vascular anatomy of the abdominal wall, preoperative imaging is essential. Computerised Tomography Angiography (CTA) has been recently described for this purpose. Uniquely, the branching pattern of the Deep Inferior Epigastric Artery (DIEA) is demonstrated clearly on CTA. We sought to correlate the branching pattern of the DIEA to the location and course of perforators, as a tool for preoperative planning.Methodology  45 hemi‐abdominal walls from both fresh and embalmed cadavers were used for isolated injection of the DIEA with contrast and radiographic imaging, allowing analysis of the location and intramuscular course of the perforators. The branching pattern on radiography was thus correlated to individual perforators.Results  DIEA branching pattern correlated closely with the intramuscular course of perforators. A bifurcating branching pattern demonstrated a reduced intramuscular transverse distance traversed by each perforator. A trifurcating (Type 3) branching pattern demonstrated perforators that traversed significantly greater transverse distances. The vessel type, however, displayed no correlation with the number of perforators.Conclusions  Intramuscular courses of perforators are significantly greater with a trifurcating branching pattern of the DIEA, and reduced with a bifurcating pattern. This correlates with less rectus abdominis muscle sacrificed during a DIEA perforator flap. As CTA is the optimal modality for demonstrating this pattern preoperatively, we suggest the use of CTA for preoperative assessment in TRAM and DIEA perforator flaps.
PR18 WHAT TYPE OF BIOPSY IS MOST USEFUL IN THE EVALUATION OF GIANT CUTANEOUS LIPOMAS? REVIEW OF THE LITERATURE AND REPORT OF FOUR CASES
Authors: Sathasivam S. , Perkins D. 
Published: April 2007

Lipomas are benign tumours of the mesenchyme that are composed of mature lipocytes. They are the most common benign mesenchymal tumours with a prevalence rate of 2.1 per 1000 people. The malignant transformation of lipomas to liposarcoma is uncommon. A few reports suggested that large tumours (>10 cm), are more likely to contain sarcomas. Hence, the preoperative biopsy is an essential component of the workup in giant lipomas since it provides key information in determining the treatment protocol. Biopsy can be performed by fine‐needle aspiration, core‐needle biopsy, incisional biopsy or excisional biopsy.We present four cases where preoperative minimally invasive biopsy techniques were utilised. In these cases, significant differences were noted between preoperative biopsies and the actual histology of the surgically resected specimen.Open biopsies have a relatively higher risk of complication but a smaller chance of misdiagnosis, while needle biopsies are less likely to present with problems but are also frequently less accurate. Given the histological heterogeneity of these tumours, a large sample from a viable area of pathology is recommended for definitive preoperative diagnosis.An open biopsy should be performed through a small incision, designed with consideration of the subsequent definitive operative procedure. A typical incisional biopsy will yield a 1–2 cm3 piece of fresh tissue for the pathologist to reliably exclude the presence of sarcoma in the lesion.