bluuebunny/crossref_metadata_2025_split huggingface dataset:
TRAUMATIC RUPTURE OF THE THORACIC AORTA: TEN‐YEAR EXPERIENCE WITH FOLLOW UP
Authors: Xabregas A. A. , Molloy P. J. , Feint J. A. 
Published: January 2008

In the past 10 years, 13 cases of acute traumatic rupture of the thoracic aorta were treated at the Dunedin Hospital. Ages ranged from 16 to 77 years, with a mean of 27 years. Twelve of the patients were involved in high speed motor vehicle accidents and one sustained a fall. The diagnosis was suspected in all 13 cases by a widened mediastinum on plain chest X‐ray and confirmed by aortography in all cases. Associated injuries were common. The time interval from injury to surgery ranged from 5 h to 16 days, with a mean of 3 days.A Gott Shunt was used in five patients, seven had partial bypass and one had simple aortic cross‐clamping. Mean aortic cross‐clamp time was 62min. Mortality was 15%, both deaths occurring in the bypass group. There were two cases of paraplegia, one occurring in the bypass group and the other in the patient having simple cross‐clamping of the aorta.Follow up was possible in 8 of 13 patients and ranged from 3 months to 10 years, with a mean of 39 months. Delayed death due to heart failure occurred after discharge in a 77 year old man 40 days after operation. The long‐term results were satisfactory in all survivors, apart from one poorly rehabilitated paraplegic.
DELAYED HYPERSENSITIVITY REACTION TO SUBCUTANEOUS HEPARIN
Authors: Rivers Jason K. , Gianoutsos Mark P. 
Published: January 2008

Two women developed well‐demarcated eczematous and erythematous plaques localized to the injection sites of subcutaneous preservative‐free heparin 72–96h after heparin administration. The plaques resolved within a week of discontinuing the therapy. Neither epicutaneous testing with preservative‐free heparin nor in vitro proliferation assays to heparin and two low molecular weight glycosaminoglycans could elicit a response in either patient. In contrast, both patients developed localized eczematous plaques 48–96 h after re‐challenge with intradermal and/or subcutaneous heparin.Delayed hypersensitivity reactions to subcutaneous heparin are uncommon and have not been reported in the Australasian medical literature. Given the frequency with which heparin preparations are used, it is important for physicians and surgeons to be aware of this potential adverse reaction.
CLINICOPATHOLOGICAL FEATURES OF PRIMARY GASTROINTESTINAL LYMPHOMAS: A STUDY OF 42 CASES
Authors: SenGupta S. K. , Sinha S. N. 
Published: January 2008

The clinicopathological features of 42 patients with gastrointestinal lymphoma during the period 1982–88 are described. Ten cases (23.8%) were seen in the stomach, 23 cases (54.8%) in the small intestine and 9 cases (21.4%) in the large intestine. In 4 cases multiple sites were involved. The tumours occurred most frequently in the 2nd to 4th decade. Histologically, using the working formulation for non‐Hodgkin's lymphoma, all were found to be diffuse and mostly of the high grade type (45%). Seven lymphomas were seen in children. Three were of the Burkitt's type.Patients presented quite late in a large number of cases (43%). Compared with most other published series small intestinal involvement was common. There was a high incidence in males. Predominant small intestinal involvement did not result in malabsorption syndrome and primary lymphomas constituted 3.5% of all malignancies of the gastrointestinal tract.
COMPARISON OF LENGTH OF STAY AFTER HERNIA REPAIR IN TWO VICTORIAN HOSPITALS
Authors: Collopy Brian T. , Cade Richard J. , Cocks John R. , Davis Catherlne A. 
Published: January 2008

The objective of this study was to ascertain factors which determine the length of stay in relation to adult patients admitted for hernia surgery in two different hospitals. It was conducted prospectively on a total of 141 patients, 82 in a central hospital and 59 in a district hospital.There were no significant differences with regard to age, sex, type of hernia, pre‐existing disease and postoperative complications. There was a significant difference between the average length of stay in the two hospitals (6.7 days in the central hospital and 3.9 days in the district hospital).There was a longer pre‐operative stay in the central hospital through administrative problems, availability of operating time and admission for pre‐operative investigations.In the postoperative period there was a significant difference between the day of operation and the time the surgeon stated that the patient could be discharged (i.e. the surgically advised discharge (SAD) date). This period was 4 days at the central hospital, as against 2 days at the district hospital. Once the SAD date was determined, there was no difference between the two hospitals with regard to placement.Consideration should be given to improving admission practices, including patient ‘work‐up’ in the preadmission phase and to shortening the postoperative stay after hernia surgery.
MANAGEMENT OF SPLENIC TRAUMA: A NEW CT‐GUIDED SPLENIC INJURY GRADING SYSTEM
Authors: Sugrue M. , Knox A. , Sarre R. , McIntosh N. , Toouli J. 
Published: January 2008

The aim of this study was to assess a newly developed computerized tomography (CT)‐based splenic injury index in predicting the outcome of splenic injury. Twelve patients with isolated splenic injuries were studied. Splenic parenchymal injury was graded from 1 to 4 based on CT. The splenic injury index was obtained by multiplying the parenchymal score by the volume of haemoperitoneum, which was measured on the CT scanner. The 12 patients with CT‐proven splenic injuries had a mean injury index of 193.5 ± 191 (mean ± s.d.). The 3 patients who failed conservative management had a mean index of 475 ± 50, compared with an index of 99.5 ± 100 in the nine managed non‐operatively (P < 0.001).This new CT‐based splenic injury index allows morphological assessment of splenic injury and may predict the outcome of splenic trauma.
COMPARATIVE STUDY OF SKIN CLOSURE IN HIP SURGERY
Authors: Clayer M. , Southwood R. T. 
Published: January 2008

A prospective, randomized controlled study was performed to compare skin staplers for closure of skin following hip surgery. Patients were randomized to have their skin closed with either continuous subcuticular non‐absorbable polypropylene ‘prolene’ suture (33 patients) or metal skin staples (Autosuture ‘Premium’ or Davis and Geck ‘Oppose’; 33 patients).All patients received prophylactic cephalosporin (Cephalothin) in pre‐ and postoperative antibiotic therapy. The wounds were examined daily and the presence of discharge, wound dehiscence and infection were noted. Any discharge at 7 days was swabbed for microbiological examination. The final cosmetic appearance was assessed at 8–12 weeks postoperatively. Scar length and width were measured and the presence of cross‐hatching noted.Wound dehiscence occurred in 1 patient (closed with staples). Wound infection developed in 2 patients at a rate of 3% (1 patient from each group). At final review (8–12 weeks postop.), the scar produced by subcuticular prolene was narrower than that produced by the skin stapler (P < 0.05). There was no significant difference in scar width between a wound which had staples removed at 10 days post operation and one where the staples were removed at 14 days. Staple insertion sites were more obvious in scars that had had the staples removed at the later time (P < 0.05).
INFECTION OF VASCULAR PROSTHESES
Authors: Fletcher J. P. , Dryden M. , Sorrell T. C. 
Published: January 2008

Graft infection occurred in 11 of 322 patients (3.4%) who had insertion of a vascular prosthesis for peripheral vascular disease during a 4‐year period. The groin was the most common site of infection and multiple resistant Syaphyococcus aureus (MRSA) was the most common organism responsible.Six of 7 MRSA infections occurred following a procedure involving a previously placed graft and/or a groin incision. Prophylactic antibiotics effective against MRSA are recommended for patients having a revisional procedure, especially involving the groin.
POLYTEF PASTE FOR URINARY INCONTINENCE
Authors: Smart R. F. 
Published: January 2008

A series of 28 patients injected with polytetrafluoroethylene (F'TFE) (Polytef, Mentor) paste for urinary incontinence is presented.The cystoscopic method of injection was used in 25 patients. Twenty‐four adult females with stress incontinence were treated; 10 of these were long‐term cures and five improved. Success rates were higher in those who had had previous gynaecological surgery (10 of 12; P < 0.05) or who had well supported vaginal walls (5 of 5; P < 0.05). Three adult males were treated, but all failed.Complications including the risk of micro‐embolization are discussed. Low morbidity is an attraction and it is concluded that this treatment may have a place for older women with stress incontinence and a well‐supported, preferably scarred, anterior vaginal wall. It may be performed under topical local anaesthetic if desired.The availability of a more suitable agent would widen the application of the technique. Subject to long‐term experience vindicating early trials, glutaraldehyde cross‐linked collagen may be a suitable replacement for PTFE in this role.
PHYSICS AND FUNCTION OF OPERATING ROOM SUCTION
Authors: Meagher Alan P. , Hugh Thomas B. , Li Bei , Montano Stewart R. 
Published: January 2008

A study was done to evaluate the performance of suction apparatus in the operating room. The investigation was prompted by perceived poor suction performance in a suite of new operating rooms built in accordance with Standards Australia (SA) specifications.SA performance tests were conducted on each of four suction outlets in nine operating rooms. All 36 outlets complied with SA standards for flow‐rate (minimum 40 Umin) and occluded negative pressure (ONP: minimum ‐60kPa). However, 24 collection units failed to comply with standards (ONP) of ‐40kPa achieved in < 4 s when a 4 L disposable suction apparatus was connected (mean time to ONP 6.1 s, 95% confidence interval: 4.9, 7.3). When smaller capacity suction jars were substituted, more units met SA standards. The standards therefore need revision to include specification of the capacity of the collecting apparatus.Other factors that were found to degrade suction performance significantly were air leakage and defective shut‐off valves.The physical principles involved in operating room suction are described. Surgeons and anaesthetists should understand these principles, and it is recommended that a simple pre‐operative check of the suction apparatus should be carried out, as follows:(1) Turn the wall control knob fully on, and disconnect the suction apparatus. The gauge should register zero.(2) Connect the suction jars. If the indicated gauge pressure is in excess of ‐15kPa, investigate the equipment for excessive resistance, particularly in the shut‐off valve, which should be replaced with a new unit if necessary.(3) Occlude the suction jar inlet with a finger, and note the time taken for the gauge pressure to reach ‐40kPa. If this exceeds 4 s. investigate the system for leaks. If none are found, consider using smaller capacity collection jars
PARS INTERARTICULARIS STRESS AND DISC DEGENERATION IN CRICKET'S POTENT STRIKE FORCE: THE FAST BOWLER
Authors: Annear P. T. , Chakera T. M. H. , Foster D. H. , Hardcastle P. H. 
Published: January 2008

Cricket fast bowlers are the potent strike force in a multidiscipline team. They subject their spines to repetitive sagittal plane and rotatory movements over many years. The effect of this repetitive stress has not previously been analysed. This study examined 20 former fast bowlers to determine the incidence of spondylolysis, spondylolisthesis and degenerative change.Fast bowlers are noted to have an increased incidence of spondylolysis. A mixed front/side bowling style involving more lumbar hyperextension or rotation has significant association with spondylolysis when compared with side‐on bowling styles.There was a high incidence of radiological thoracolumbar degenerative facet joint and disc disease in former fast bowlers.
HEPATIC CAVERNOUS HAEMANGIOMA: A 10 YEAR REVIEW
Authors: Tait N. , Richardson A. J. , Muguti G. , Little J. M. 
Published: January 2008

Between January 1981 and July 1991, 61 patients with hepatic haemangiomata were examined at Westmead Hospital. There were 14 males (22%) and 47 females (78%). The age range was 26–85 years with a median of 49 years. Forty‐one had abdominal symptoms but these could be attributed to a haemangioma in only seven cases. There was at least one subcapsular lesion in 17 (28%). Six of the seven symptomatic lesions were subcapsular and five of these were giant haemangiomata (i.e. more than 4 cm in greatest diameter). One large symptomatic lesion was intrahepatic. No association was observed between hepatic haemangiomata and other hepatic or extrahepatic diseases. Haemangiomata were resected from six patients, four of whom were symptomatic. Symptoms improved in all four but did not resolve completely in any. Follow‐up ranged from nil in five patients to 108 months in one. The median follow‐up was 12 months after initial diagnosis. Ten patients showed evidence of change in their lesions or symptoms while under observation. Only three had worsening symptoms or suspected change in size of a haemangioma.This study highlights the benign, static nature of most hepatic haemangiomata. When this lesion is suspected, the diagnosis should be confirmed with ultrasound (US) and labelled red blood cell scanning (RBCS). Referral for evaluation by a specialist hepatobiliary surgery unit is necessary when symptoms are intolerable, increasing size is definitely demonstrated or the diagnosis is uncertain and cannot be established without specialized investigations. Bleeding into or from these lesions is rare.
WOUND CLOSURE AND SUTURING PATTERNS: A VECTOR ANALYSIS OF SUTURE TENSION
Authors: Rubinstein C. , Russell W. J. 
Published: January 2008

When the vectors of force required to close the ideal surgical wound arc analysed, it is apparent that suture tension varies with the pattern of suture.For a given closing force, perpendicular interrupted sutures have the least tension. Symmetrical continuous sutures require greater suture tension, and this increases the more the suture is aligned with the direction of the wound. Asymmetrical (perpendicular/diagonal) continuous suturing requires more tension than interrupted sutures but this never exceeds 200%.Symmetrical suturing has slightly less tension than asymmetrical suturing when the spacing is about equal to the width of the suture. However, as the spacing ratio increases to greater than 2, the tension in the symmetrical suture rises very sharply. At a length: width ratio of 4. the symmetrical suture tension is about 70% greater than the same asymmetrical suturing.
CLINICAL DATABASES AND SURGICAL RESEARCH
Authors: Little J.M. 
Published: January 2008

Modern science is preoccupied with basic mechanisms at the level of the gene, molecule, atom and fundamental particle. This preoccupation has affected attitudes to medical science. Paradoxically, politicians and Departments of Health are largely cor cemed with clinical epiphenomena — outcomes, interventions, effectiveness, efficiency — that are often disregarded by medical scientists and viewed without favour by granting bodies. In the surgical sciences, there is renewed interest in clinical research.The small computer and the readily available database with its wmpatible statistical package have added a new dimension to clinical research. Database design and analysis are as much a part of the surgical investigator's skills as are laboratory techniques. There are simple rules that govern database design. The database should be simple and flexible, but provide an adequate patient profile. Entry should be standardized by precise inclusion criteria and precise definitions. Data input should be numerical whenever possible. The database program should convert simply to a comprehensive statistical program.The clinical database is useful for both observational and investigational studies. Case series, case control studies and cohort studies can all be developed from well maintained databases.In the Department of Surgery at Westmead Hospital, databases have been maintained for 10 years. The hepatobiliary and pancreatic group of databases have led to 34 publications. The liver tumour database has produced 12 studies and nearly 20 papers. The process of development of one study is outlined in detail. The chance observation of an excess incidence of gallstones in patients having regular ultrasound examinations after major abdominal surgery has been confirmed in a case control study. Of those patients undergoing major abdominal surgery 28% developed gallstones during 3 years of supervision. A prospective study is planned to investigate this further.The time is appropriate for clinicians to return to clinical research, for which they are uniquely trained. There should be no stigma associated with doing ‘merely clinical research’.
BLEEDING ANGIODYSPLASIA OF THE GASTROINTESTINAL TRACT
Authors: Lau W. Y. , Chu K. W. , Yuen W. K. , Poon G. P. , Li A. K. C. 
Published: January 2008

Bleeding angiodysplasia of the gastrointestinal tract poses frustrating challenges to clinicians because these minute vascular lesions are difficult to diagnose pre‐operatively and to locate intra‐operatively. During the past 12 years, 24 patients were treated for histopathologically confirmed bleeding angiodysplasia of the gastrointestinal tract. Pre‐operative investigations and intra‐operative localization followed a fixed protocol for patients with gastrointestinal bleeding of obscure origin.The median follow‐up of these 24 patients was 51 months and the results of treatment for 22 patients were excellent. Two patients had recurrent bleeding but investigations failed to determine the bleeding source.
SEX AND SUBSITE FREQUENCY OF LARGE BOWEL CANCER IN THE KINGDOM OF SAUDI ARABIA: A COMPARISON WITH NEW ZEALAND
Authors: Isbister William H. 
Published: January 2008

New Zealand (NZ) has a high risk population for the development of large bowel cancer (LBC). The Kingdom of Saudi Arabia (KSA) has a low risk population and is estimated to have incidence and mortality rates which are ten times lower than NZ. It has already been shown that in NZ, females have a higher incidence of right‐sided colonic cancer and males a higher incidence of rectal cancer. To determine whether the same situation exists in a low risk population the NZ data were compared with similar data from the cancer registry at the King Faisal Specialist Hospital and Research Center (KFSHRC).Between 1975 and 1989. 423 Saudi and Yemeni patients with LBC were registered at KFSH. The subsite distribution of tumours in this group were compared with the subsite distribution in 4678 patients registered in NZ between 1972 and 1975.The male to female (M:F) ratio for right‐sided tumours in KSA was 1:0.90 compared with 1:156 in NZ whereas the ratios for rectal tumours were 1:0.61 and 1:0.83 respectively.This study confirms the presence of a lower frequency of right‐sided tumours in females in a low risk country and further confirms the importance of gender in LBC. It may be that early and multiple child bearing, physical activity and relatively poor diets have been protective for Saudi females.
CORONARY ARTERY BYPASS SURGERY IN YOUNG PATIENTS
Authors: Sim Eugene K. W. , Lee Chuen Neng , Mestres Carlos A. , Lim Lian Ching , Adebo Oluwole A. , Tan Christie T. T. 
Published: January 2008

Coronary atherosclerosis is being increasingly observed in young patients. However results of surgery in such patients have so far been disappointing both in terms of operative mortality, symptomatic relief and long‐term survival. Reasons given for this include the increased prevalence of risk factors in young patients and a higher incidence of graft occlusion. In the treatment of Asian patients, a further negative factor is the belief that coronary artery disease is more often diffuse and the vessels smaller. Between January 1987 and May 1991, a total of 66 patients under the age of 45 years at the time of surgery had coronary artery bypass grafting performed. The demographic, clinical, angiographic and operative data were analysed. Eighty‐nine per cent of the patients were male and their racial distribution was 63% Chinese, 8% Malays, 26% Indians and 3% Others. Their mean age was 40.8 years. The presence of risk factors was high: 45.6% had hypertension; 34.8% were smokers; 21.2% had diabetes mellitus; and 12.1% had hyperlipidaemia. The main indication in these patients was either angina or a previous myocardial infarction (53%). There were no patients with peri‐operative infarction diagnosed by the presence of new Q wave. There was no hospital death. The stay of the patients ranged from 6 to 28 days with a mean of 10 days. Follow‐up ranged from 3 to 54 months. There were no late deaths.It was concluded that there is a high incidence of risk factors among young patients with coronary artery disease, which follows the pattern of many other studies. The operative risk in these patients is low and morbidity is minimal. The intermediate results of bypass grafting appear to be excellent.
THE ROLE OF ERCP AND ENDOSCOPIC SPHINCTEROTOMY IN THE ERA OF LAPAROSCOPIC CHOLECYSTECTOMY
Authors: O'Rourke N. A. , Askew A. R. , Cowen A. E. , Roberts R. , Fielding G. A. 
Published: January 2008

The advent of laparoscopic cholecystectomy (LC) has led to some controversy regarding the best method of managing bile duct calculi. This paper reviews the cases of 38 patients who underwent LC and endoscopic retrograde cholangiopancreatography (ERCP), from a series of 600 consecutive laparoscopic cholecystectomies. Twenty‐nine patients had ERCP performed pre‐operatively because of suspicion of choledocholithiasis. Duct stones were confirmed in eight patients. Recent or current jaundice was the best predictor of bile duct stones. Nine patients had ERCP done postoperatively because of duct stones seen on operative cholangiography. In two patients bile duct cannulation was not possible and a third procedure, open duct exploration, was necessary.Techniques in laparoscopic management of duct stones are improving and the role of ERCP and sphinc‐terotomy should be limited to jaundiced patients or those with proven bile duct stones in whom laparoscopic procedures have been unsuccessful.
CARL LANGENBUCH AND THE LAZARUS HOSPITAL: EVENTS AND CIRCUMSTANCES SURROUNDING THE FIRST CHOLECYSTECTOMY
Authors: Hardy Kenneth J. 
Published: January 2008

Carl Langenbuch performed the first cholecystectomy at the Lazarus Hospital in Berlin in July 1882. This operation followed scientific experiment, careful thought, cadaver dissections and careful patient selection.Langenbuch's career was linked with the Lazarus Hospital in Berlin, to which he was appointed as Director at the age of 27. The hospital was then 4 years old and in a poor area of Berlin, and they grew in reputation together. Going through repeated troubled times. this hospital has withstood financial disaster, three wars, an occupation and the ambitions of administrators and developers.Treatment for cholecystitis before Langenbuch was stone extraction from spontaneous cutaneous biliary fistula or skin incision of near‐pointing empyema. Cholecystostomy was carried out by Bobbs (I 867). by Sims (1878), and championed by Kocher (1878) and Tait (1879). Langenbuch carried out a cholecystectomy in 1882 and subsequently recommended choledochotomy, duodenotomy and sphincterotomy in the management of stones in the bile ducts. He carried out one of the earlier major right liver resections in 1888. Also, he was famous for his sciatic nerve stretching for tabes dorsalis, management of gunshot wounds and his dissertations at the German Surgical Society before becoming renowned for cholecystectomy.The surgical world owes Langenbuch proper acknowledgement for his contribution to hepatobiliary surgery.