bluuebunny/crossref_metadata_2025_split huggingface dataset:
UNEXPLAINED SEPTICAEMIA AND PNEUMOPERITONEUM IN VIETNAMESE BOAT PEOPLE: A SELF‐INFLICTED CONDITION?
Authors: Chung C. C. , Cheng C. W. , Lau W. Y. , Li A. K. C. 
Published: January 2008

Background: Ten Vietnamese boat people with septicaemic shock or pneumoperitoneum were admitted between April and July 1993.Methods: In order to investigate the cause of unexplained septicaemic shock and spontaneous pneumoperitoneum in Vietnamese boat people, an audit was carried out. Attention was paid to the mode of presentation, abnormal physical signs, presence of injection marks, radiological signs, subsequent progress and outcome.Results: The clinical and radiological findings were all in favour of self‐inflicted conditions. A retrospective review from the hospital record revealed that the emergency admission rate and disappearance rate of the Vietnamese boat people was higher than those of other patients (P < 0.001).Conclusion: It is concluded that self‐inflicted conditions are a serious problem among the Vietnamese boat people, who may use hospital admission to avoid the detention centre.
A COMPARISON OF REUSABLE VERSUS DISPOSABLE LAPAROSCOPIC INSTRUMENT COSTS
Authors: Eddie G. , White S. 
Published: January 2008

Background: Between 1991 and 1993 a single set of reusable laparoscopic instruments was used to perform 404 cholecystectomies, 102 hernia repairs and 66 advanced procedures. Disposable instruments were used only when no suitable reusable instrument was available or when reusable instruments were not working to the satisfaction of the surgeon.Methods: The cost of performing those laparoscopic operations using this policy was calculated by adding the purchase cost,the maintenance costs and the repair and replacement costs of the reusable instruments. To this figure was added the cost of disposable instruments which were used instead of reusable instruments during the study period.Results: The total cost was $253 385, at an average of $443 per case. The cost per case for reusable instruments remained approximately $100 through the 3 years, while the cost per case of disposable instruments fell from almost $600 in 1991 to about $200 in 1993.Conclusions: Our future policy is to continue using reusable instruments initially, with backup disposable instruments.
MESH HERNIOPLASTY USING A STAPLER
Authors: NG E. K. W. , Lam Y. H. , Lee D. W. H. , Chan A. C. W. , Li A. K. C. , Chung S. C. S. 
Published: January 2008

Background: The recent development of laparoscopic hernioplasty has evoked extensive re‐examination of the safety and effectiveness of using synthetic mesh materials in hernia surgery. We have investigated the efficacy of anterior stapling mesh repair in the treatment of inguinal hernia.Methods: From July 1993 to June 1994. a modified open mesh hernioplasty using staples for anchorage has been performed in 127 patients.Results: The mean age of patients was 61.4 13.0 years. Over 90% of them were operated on under local anaesthesia. The operation time ranged from 30 to 95 min with a median of 39 min. Only sixteen patients (12.6%) required postoperative parenteral analgesics and the median time for resuming daily activities was 7 days. Apart from two patients with reactionary haemorrhage, there was no other significant complication observed. Only one recurrence was encountered over the 26‐month median follow‐up period.Conclusions: We conclude that the modified mesh hernia repair with a stapling device is a feasible, inexpensive and safe procedure that is well tolerated under local anaesthesia by most patients.
OESOPHAGOGASTRECTOMY WITH AN ANASTOMOSIS USING LINEAR STAPLERS
Authors: Bird Peter , Daniel Fredy , MacLellan Donald 
Published: January 2008

Background: Fibrous stricture formation causing dysphagia after oesophagogastrectomy with a circular stapled or sutured anastomosis remains a significant complication, occurring in up to one‐third of cases. An anastomosis that avoids this complication would be desirable, given that resection is often performed to palliate dysphagia. We describe a technique of oesophag‐ogastric anastomosis using linear staplers which eliminates the postoperative complication of fibrous stricture formation.Method: A retrospective analysis of 111 consecutive patients who underwent oesophagogastrectomy for neoplasm or benign oesophageal stricture between March 1980 and April 1991 was carried out. Cadaveric models of the anastomosis were constructed and compared to models of circular stapled anastomoses.Results: An anastomosis using linear staplers was used in 111 patients with a leak rate of 2.7%, 30‐day and hospital mortality rates of 5.4% and 8.1%, respectively, and no benign stricture formation. In the cadaveric models, the cross‐sectional areas of the linear stapled anastomoses were greater than those of the circular stapled anastomoses, suggesting that this is an important factor in preventing fibrous stricture formation.Conclusions: An anastomosis using linear staplers can be performed with a low leak rate, an acceptable operative mortality and no benign stricture formation. We suggest that an anastomosis using linear staplers should be the preferred type of anastomosis in oesophagogastrectomy.
COLORECTAL RESECTION IN VICTORIA: A COMPARISON OF HOSPITAL BASED AND INDIVIDUAL AUDIT
Authors: Thompson G. A. , Cocks J. R. , Collopy B. T. , Cade R. J. , Ewing H. P. , Ogerson J. W. R. , Turner P. L. 
Published: January 2008

Background: The results of personal audit have not been tested against a hospital‐based audit previously and the results of two such audits of colorectal resection in the State of Victoria have provided this opportunity. In addition, data reflecting the results of colorectal resection across a range of hospitals and surgeons in the Victorian community have been obtained.Methods: A total of 535 patients undergoing a colorectal resection, with an anastomosis performed, were studied in two serially conducted prospective audits arranged by the Standards Sub‐committee of the Victorian State Committee. One study was public hospital‐based and the second was based on voluntary reporting by individual surgeons.Results: Similar results were obtained in each study, demonstrating the accuracy of individual reporting. The combined results (wound infection rate 12.3%. anastomotic leak rate 3.7% and mortality 4.5%) are compared to previously published data.Conclusions: In the State of Victoria the results of audit by individual surgeons performing colorectal resection were similar to the hospital‐based audit. The results obtained compare favourably with previously published data.
BLEEDING GIANT GASTRIC ULCER
Authors: Yii M. K. , Hunt P. S. 
Published: January 2008

Background: A consecutive series of 269 cases of bleeding gastric ulcer were studied prospectively from 1979 to 1993 inclusive.Method: Fifty‐five (21%) had a giant gastric ulcer with a diameter of 3 cm or more. These cases were compared with those with ulcers less than 3 cm in diameter in terms of clinical details, prognostic factors, urgent operation and outcome.Results: Death occurred in 13 cases (5%), urgent surgery was performed in 75 cases (29%) and there were 11 postoperative deaths (15%) within a month of surgery. The patient details in the two groups matched in terms of age, sex distribution, ulcer history, previous complication and recent ingestion of analgesics. Clinical comparison showed that giant ulcer had a poorer prognosis with a higher mortality (10 vs 3%, P < 0.01), urgent surgery rate (65 vs 12%, P < 0.01) and operative mortality (23 vs 11%, difference not significant). Study of risk factors in patients with giant ulcer revealed significantly more with concurrent illness, shock, anaemia and endoscopic stigmata of recent haemorrhage.Conclusion: More severe bleeding and poorer general condition in the giant ulcer group stresses the importance of early diagnosis and accurate resuscitation in these patients. Survival depends on optimal condition and prompt and timely surgery.
A SELF‐EXPANDING ENDOLUMINAL GRAFT FOR TREATMENT OF ANEURYSMS: RESULTS THROUGH THE DEVELOPMENT PHASE
Authors: Gordon M. K. , Lawrence‐Brown M. M. D. , Hartley D. , Sieunarine K. , Holden A. , MacSweeney S. T. R. , Hellings M. J. 
Published: January 2008

Background: The results of two and a half years' experience of endoluminal treatment of aneurysmal disease (from March 1993 to December 1995) are reported.Methods: The endoluminal grafts were individually made at Royal Perth Hospital. They are based on Dacron‐covered stainless steel self‐expanding ‘Z’ stents with Gianturco barbed stents (Cook Pty, Australia) for proximal anchorage for grafts within the aorta,Results: Fourteen straight tube grafts (nine for aortic aneurysm, four for iliac aneurysm and one for subclavian aneurysm) and 24 bifurcate grafts were deployed; all were in patients considered high‐risk for conventional repair. Seventy‐two per cent of the straight tube grafts successfully excluded the aneurysm. The bifurcate grafts, in use since July 1994, successfully excluded the aneurysm in 88%. There were two delayed deaths from rupture after the grafts failed to exclude the aneurysms; two patients required conversion to open repair and survived; three patients have persistent endoleaks; and three of the bifurcate grafts subsequently occluded a graft limb but did not require further intervention. Ninety per cent of these complications occurred in the first half of the series (prior to January 1995).Conclusions: A learning and development curve was clearly apparent. The results thereafter compare favourably to those for open repair in similar high‐risk groups, suggesting that these techniques hold promise for all patients with aneurysms.
PROGNOSTIC SIGNIFICANCE OF c‐erbB‐2 ONCOGENE IN AXILLARY NODE‐NEGATIVE BREAST CANCER
Authors: Molland J. G. , Barraclough B. H. , Gebski V. , Milliken J. , Bilous M. 
Published: January 2008

Background: With the advent of screening mammography more breast cancer will be detected at an earlier stage, apparently confined to the breast with no nodal involvement. However, 30% of these will recur due to micrometastases present at the time of diagnosis. Chemotherapy and tamoxifen have been shown to improve disease‐free survival in axillary node‐negative patients but not overall survival. In the search for a useful predictor of breast cancer recurrence the relationship between c‐erbB‐2 expression and recurrence and survival was examined.Methods: Eighty‐eight axillary node‐negative breast cancer patients were followed up for at least 5 years.Results: There was a significant relationship between c‐erbB‐2 expression and both tumour recurrence (P < 0.001) and poorer survival (P = 0.003). In a Cox multiple regression analysis, c‐erbB‐2 staining remained the only significant prognostic variable for recurrence (P= 0.002) and survival (P = 0.032). Tumour recurrence in c‐erbB‐2‐positive cases tended to occur early in the course of follow up and was associated with poorer survival.Conclusion: C‐erbB‐2 was found to be a useful prognostic indicator for early recurrence and poorer survival in axillary node‐negative breast cancer patients.
SURGICAL RESECTION OF PULMONARY METASTASES FROM NASOPHARYNGEAL CARCINOMA
Authors: Cheng L. C. , Sham J. S. T. , Chiu C. S. W. , Fu K. H. , Lee J. W. T. , Mok C. K. 
Published: January 2008

Background: Nasopharyngeal carcinoma (NPC), unlike other head and neck cancers, is known for its propensity for distant metastases. Chemotherapy remains the mainstay of treatment because of this and the chemosensitivity of the tumour, but long‐term control is rare. The surgical management of pulmonary metastases of other extrathoracic malignancies prompted this review of surgical management of patients with NPC.Methods: Thirteen thoracotomies were performed in 12 patients with pulmonary metastases as the first and only site of relapse of nasopharyngeal carcinoma. Postoperative chemotherapy was given in four patients, radiotherapy to the mediastinum in one patient and both chemotherapy and radiotherapy in two patients. The survival pattern of this group of 12 patients was compared with a historical control group consisting of 65 patients without surgical resection.Results: Lymph node involvement was documented in four patients during operation. Four patients relapsed after surgical resection, two of them were from the group of three patients with lymph node involvement. The site of subsequent relapse was the lung for three patients and the skeletal system for the fourth. The 2 year actuarial survival of the surgically resected group compared favourably with the historical control group (80% and 24.1 %, respectively; P= 0.0002 by Mantel‐Cox test).Conclusions: Surgical resection of pulmonary metastases from NPC seems to be a promising approach though the effect of case selection cannot be excluded and further studies are indicated. The importance of exploration and dissection of mediastinal nodes in the surgical management of pulmonary metastases from NPC was demonstrated.
SIGMOlD AND GASTRIC TONOMETRY DURING INFRARENAL AORTIC ANEURYSM REPAIR
Authors: Englund R. , Lalak N. , Jacques T. , Hanel K. C. 
Published: January 2008

Background: The value of the sigmoid tonometer in predicting sigmoid ischaemia and postoperative enteric organism infection has been reported but the value of tonometric measurements has been challenged. The purpose of this study was to examine the use of tonometric measurements in a series of patients undergoing infrarenal aortic aneurysm repair.Methods: We assessed the results obtained when sigmoid (n= 11) and gastric (n = 8) tonometry were performed in patients undergoing infrarenal aortic aneurysm repair (n= 11). We measured blood flow ultrasonically (n = 6) in the inferior mesenteric artery (IMA) and IMA stump pressures. Sigmoid and gastric tonometry were measured prior to clamping of the infrarenal aorta, during cross clamping and after clamp release at 1, 4, 16 and 20 h. Ultrasonic flow was measured before clamping. Stump pressures in the IMA were measured before, during and after clamping.Results: The IMA was chronically occluded in five patients. The IMA flow was 37.5 ± 8.7 mL/min (mean ± s.e.). The mean IMA stump pressures before, during and after clamping were 64 ± 13, 48 ± 8 and 69 ± 10 mmHg, respectively, and did not differ significantly. Mean systematic arterial pressures at these times were 89 ± 7, 95 ± 5 and 86 ± 8 mmHg. These did not differ significantly or when compared with IMA stump pressure. The gradient between systemic arterial pressure and IMA stump pressure did not vary significantly at any of these times. Sigmoid and gastric intramucosal pH (pHi) did not differ significantly at any of the above times. Both sigmoid and gastric pHi dropped on clamp application but 4 h afterwards had returned to baseline levels. Systemic arterial pH reflected significant ischaemia during clamping and shortly after release of the clamp (P= 0.008).Conclusions: Tonometry may reflect systemic events as much as regional ischaemia. Useful tonometry results may depend on the development of a trend rather than individual measurements. The routine use of tonometry to detect intestinal ischaemia may not be cost‐effective in aortic surgery.
LAPAROSCOPIC MESH REPAIR OF RECURRENT INGUINAL HERNIA
Authors: White S. I. , O'Rourke N. , Fielding G. A. 
Published: January 2008

Background: Pre‐peritoneal mesh repair has been a long‐standing technique for recurrent hernias. Laparoscopic technique has been applied to this operation with the aim of assessing its results at early follow up of 1 year.Methods: The outcome in 56 patients was reviewed and all patients contacted 12 months after surgery.Results: There was one immediate failure at 1 week, needing a further operation. There were no other recurrences at 1 year. Ten patients had minor postoperative complications.Conclusions: At early follow up, this is a satisfactory technique for recurrent hernias.
FACTORS AFFECTING MORBIDITY AND MORTALITY FOLLOWING SURGICAL INTERVENTION IN PATIENTS WITH INTRACRANIAL MENINGIOMA
Authors: Turgut M. , ÖZcan O. E. , Benli K. , ÖZgen T. , Gürçay ö. , Bertan V. , Erbengi A. , Saĝlam S. 
Published: January 2008

Background: Meningiomas usually grow slowly but they may cause recurrences despite surgical resection. The impact of clinical, neuroradiological and surgical characteristics on operative morbidity and mortality of patients operated on for intracranial meningioma was analysed.Methods: A series of 450 patients operated on for intracranial meningiomas at the Department of Neurosurgery, Hacettepe University Hospital during the period 1964–92 is reported. The surgical results were analysed with regard to intracranial site, extent of removal, histological type, and different time periods. Computed tomography (CT) and magnetic resonance imaging (MRI) facilitated the diagnosis and helped with the planning of treatment.Results: Two hundred and ninety‐two patients were examined with both CT and MRI. Overall mortality was 4% but showed a decline from 9% in the pre‐CT era to 3% in the post‐CT era and to 1% in the past 3 years.Conclusions: Operative mortality and recurrence rates are affected by the intracranial location of the tumour, histological type, and extent of tumour removal. Emphasis is also given to the importance of the introduction of the imaging techniques, and the microsurgical techniques with the Cavitron ultrasonic surgical aspirator (CUSA), laser, and/or bipolar coagulator which have further improved the operative mortality and recurrence rates.
INTERTROCHANTERIC FRACTURES OF THE FEMUR: A RANDOMIZED PROSPECTIVE COMPARISON OF THE GAMMA NAIL AND THE AMBl HIP SCREW
Authors: Hoffman C. W. , Lynskey T. G. 
Published: January 2008

Background: The Gamma nail has been introduced as an advance over the Ambi hip screw in intertrochanteric femoral fractures. Its efficacy in an Australasian setting has not been documented.Methods: A prospective randomized study was used to compare the Ambi hip screw and the Gamma nail for the treatment of 69 patients over the age of 50 years with intertrochanteric femoral fractures. The groups were similar with respect to age, sex, prefracture mobility and abode, anaesthetic risk grade, CT measured bone density and fracture pattern.Results: Those treated with the Gamma nail had a significantly longer image intensifier screening time (P <0.05), greater blood loss (P<0.01) and more operative complications. There was no difference in the length of hospital stay but the level of mobility recovered was significantly better in the Ambi group at 6 months follow up. Urine retention was the most frequent complication but did not correlate with the implant or method of anaesthesia. Two implants cut out, one in each group. Limb shortening was similar in both groups and was not affected by leaving the Gamma nail unlocked distally in unstable fractures. Thirteen patients died from pre‐existing medical conditions.Conclusions: The Gamma nail proved technically more demanding with higher intra‐operative complications and inferior return of mobility.
TREATMENT OF HUMERAL SHAFT FRACTURES WITH THE SEIDEL INTRAMEDULLARY NAIL
Authors: Bain G. I. , Sandow M. J. , Howie D. W. 
Published: January 2008

Background: The use of intramedullary nails for the management of humeral shaft fractures has been controversial. Recently, the Seidel nail has become available. The purpose of this study was to review our initial experience with the Seidel nail.Methods: A retrospective clinical and radiographic review of 25 consecutive patients treated with Seidel intramedullary humeral nail was performed. The nail was used for non‐union in 10 patients, delayed union in four, acute fracture in eight and pathological fracture in three. Eighteen of the 19 survivors were clinically reviewed at an average of 15 months (range 8–25). Pain, function, satisfaction, shoulder power, range of motion and clinical outcome were graded using the UCLA shoulder score.Results: Pain was present at the shoulder in four patients and at the fracture site in nine. Average shoulder abduction was 99° and nine patients could not abduct the shoulder past 90°. Sixty‐six per cent of patients reviewed were graded as only fair or poor using the UCLA shoulder score. In three patients rotational control was not achieved with the distal locking device at the time of surgery. Complications included non‐union in 10 patients and three intra‐operative fractures.Conclusions: Non‐union was more likely to occur if rotational control was not obtained, or if the patient had the nail inserted for a previous non‐union. Use of the Seidel nail frequently leads to shoulder pain and dysfunction. The distal locking device is unreliable and predisposes to non‐union. We do not recommend the continued use of the Seidel nail.
PRIMARY PERITONITIS IN CHILDREN
Authors: Kimber Chris P. , Hutson John M. 
Published: January 2008

Background: Primary peritonitis is a rare cause of the acute abdomen in children. It is often found at laparotomy for suspected appendicitis, or diagnosed by paracentesis in a child with an associated medical disorder.Methods: Our experience over the past 5 years with this condition at the Royal Children's Hospital is reviewed and compared with a larger series previously published from the same institution 25 years ago.Results: There were 26 cases from 1989 to 1994; 22 (85%) were female and 6 (23%) of the patients had a major underlying medical disorder.Conclusions: The incidence of primary peritonitis has remained unchanged at this institution since 1970 (4.7 cases per year), but neonatal primary peritonitis is no longer seen. Primary peritonitis is more common in females in whom there is no clear aetiology, but is presumed to be related to the retrograde passage of organisms through the genital tract. By contrast, in males primary peritonitis is rare but may be related to underlying medical conditions such as α‐I‐antitrypsin deficiency and renal disease.
INTENSIVE CARE UNIT ADMISSIONS FOLLOWING LAPAROSCOPIC SURGERY: WHAT LESSONS CAN BE LEARNED?
Authors: Hayes C. , Ambazidis S. , Gani J. S. 
Published: January 2008

Background: Laparoscopic surgery has been widely embraced, often without adequate data concerning the range and incidence of complications. In the present series, our experience of complications requiring Intensive Care Unit (ICU) admission following laparoscopic surgery is described.Methods: The records of patients requiring ICU admission at John Hunter Hospital (JHH) following laparoscopic surgery over a 39 month period were retrospectively reviewed by an independent multidisciplinary panel.Results: Twenty‐three ICU admissions were identified. Twenty‐one followed general surgical laparoscopic procedures and two followed gynaecological laparoscopies. Ten cases were operated on initially at JHH and 13 were transferred from other hospitals. During the study period, 2444 laparoscopic surgical cases were performed at JHH; 725 general surgical procedures (1.37% admitted to ICU) and 1719 gynaecological procedures (no ICU admissions). Twelve cases suffered surgical complications (including five gastrointestinal tract perforations and three biliary tract injuries) and 11 cases were admitted for non‐surgical problems. In 75% of surgical complications there was delay in diagnosis of more than 24 h. The duration of ICU stay for surgical complications (16.4 days) was significantly longer than for the non‐surgical group (3.9 days).Conclusions: There was a greater likelihood of ICU admission following general surgical rather than gynaecological laparo‐scopy. Fifty‐two per cent of the admissions were for surgical complications. Surgical complications are characterized by delay in diagnosis and longer ICU admission periods. Strategies to prevent some of these complications are discussed.