bluuebunny/crossref_metadata_2025_split huggingface dataset:
TN02 RADIOLOGICAL ASSESSMENT OF LIVE LIVER AND KIDNEY DONORS
Authors: Holden A. H. 
Published: April 2007

Technical success with minimal morbidity for both donor and recipient in live hepatic and renal donor surgery can be achieved by accurate pre‐operative assessment, including high quality imaging of donor hepatic and renal anatomy. Invasive imaging modalities such as angiography and ERCP have been replaced by the non‐invasive imaging modalities multidetector CT (MD‐CT) and MRI.The aims of pre‐operative imaging of potential hepatic donors include the assessment of hepatic vascular anatomy, biliary anatomy, diffuse hepatic parenchymal conditions such as steatosis, focal hepatic lesions and liver volumetry. There are constant improvements in both CT and MR technology and the local choice of modality may be influenced by availability and local expertise. Both MD‐CT and MRI can be used to assess hepatic arterial, portal venous and hepatic venous anatomy as well as liver volumetry. The temporal and spatial resolution of MD‐CT possibly allows more accurate assessment of hepatic arterial anatomy.Biliary anatomy requires accurate assessment as biliary complications are the most common cause of post operative morbidity. MRCP techniques, particularly recent 3‐dimensional free breathing techniques and MD‐CT with either oral or intravenous cholangiographic agents (CTCP) can provide high resolution cholangiographic imaging. Hepatic steatosis involving the donor is qualitatively assessed with chemical shift MR producing most sensitive assessment.MD‐CT is frequently used in the assessment of potential renal donors with arterial, venous and collecting system variants relatively common. Early main renal artery branching, capsular arteries and large systemic venous tributaries all require recognition.
TN04 BIOELECTRICAL IMPEDANCE PHASE ANGLE IN CHRONIC LIVER DISEASE AND LIVER TRANSPLANTATION
Authors: Mathur S. , McCall J. L. , Gane E. J. , Plank L. D. 
Published: April 2007

Introduction  Phase Angle (PA), determined using bioelectrical impedance, may be altered in chronic liver disease. We aimed to determine whether 1. PA predicts survival in cirrhotic patients and 2. PA improves after nutritional support and transplantation.Methods  Data were extracted from a prospective database of 252 cirrhotic patients referred for nutritional assessment and intervention (HCC excluded). Median age was 49 (16–73), 68% male. Aetiology was viral (55%), ALD (15%), cholestatic (11%), and other (19%), with median MELD 11 (6–36). Measurements included PA and total body protein (TBP). Patients were followed for a median 53 (4–93) months. Survival and logistic regression analysis were performed.Results  138 (55%) died or were transplanted during follow‐up. Low PA (<4.4%) was associated with worse survival (median 16 vs. 57 months, P = 0.02) independent of the MELD score (HR for MELD 1.18; 95% CI 1.05–1.32, P < 0.0001 and for PA 0.56; 95%CI 0.32–0.98, P = 0.046). In 93 patients followed for 100 days after nutritional intervention, TBP increased by 200g (P = 0.04) and PA increased from 4.8% to 5.2% (P = 0.0006). PA also increased from low to normal levels one year post‐OLT (4.9% to 5.7%, P = 0.0001, n = 69).Conclusion  Low PA correlates with reduced TBP and a higher risk progression to transplantation or death. PA improves after nutritional support and transplantation.
TN05 NATURAL HISTORY OF TRANSPLANT RENAL ARTERY STENOSIS
Authors: Heer M. K. , Trevillian P. R. , Hardy D. , Hibberd A. D. 
Published: April 2007

Introduction  Integrity of Transplant Renal Artery is crucial for long term survival of the graft. Literature regarding the evolution of Transplant Renal Artery Stenosis (TRAS) is scant.Method  Retrospective analysis of 1042 duplex scans in kidney transplant recipients. Duplex scan (GE VIVID 307, multiphase transducer) was used as routine screening modality. Time period 1999–2006. Total no of patients −148. Mean age 47.4 yrs. M : F: 83 : 65. Average follow up −2.45 yrs. Renal arterial ratio and peak systolic velocities were used as absolute criteria for diagnosis. Relative criteria used were parenchymal perfusion, size of kidney, resistive indices and presence of other vascular conditions.Results  Number of patients detected to have TRAS‐50. Mean age‐ 48.36 yrs. M : F: 29 : 21. Average time period for detection of stenosis – 193 days. 20 patients had ostial stenosis, 23 – mid segment, 1 at hilum, 2 – branch and 4 – throughout length of artery. Two groups: Early stenosis i.e. within 3 mo – 36(72%) patients. Late stenosis – 14 (28%) patients. Average time to detect early stenosis 74 (10–100) days and late stenosis 502 (140–1396) days. 21/36 patients in group 1 showed complete resolution of stenosis in an average time of 270 days whereas only 3/14 patients in the late group resolved at an average period of 375 days (p = 0.019).Conclusion  Routine duplex scans can detect significant numbers of TRAS. Stenosis occurring early post transplant are more likely to resolve than late occurring stenosis. Prospective controlled studies are needed to resolve the issue.
TN08 THE EARLY EXPERIENCE OF ABO‐INCOMPATIBLE RENAL TRANSPLANTATION IN AUSTRALIA
Authors: Nordstrand I. A. J. , Robertson A. J. , Francis D. M. A. , Cohney S. J. , Walker R. G. , Hogan C. J. 
Published: April 2007

Purpose  In the presence of static cadaveric donation rates, renal transplantation relies increasingly on living donors. ABO blood group incompatibility has traditionally prevented many potential living donors from donating because risk of hyperacute rejection/antibody‐mediated rejection (AbMR) with graft loss, with or without need for concurrent splenectomy and intense immunosuppression. Pre‐ and post‐transplant antibody removal and monitoring anti‐blood group antibody levels have allowed this to become a clinical possibility. We report results on the first ten ABO incompatible kidney transplants performed in Australia at The Royal Melbourne and Melbourne Private Hospitals, without splenectomy.Method  All patients underwent transplantation after two weeks of Mycophenolate Mofetil, and antibody removal (plasma exchanges or Glycosorb columns). Three patients received Rituximab pre‐transplant. Standard immunosuppression was commenced at transplantation. All patients, except one low‐titre A2/O patient, received post transplant antibody removal. None underwent splenectomy.Results  Thirty day mortality was zero, and at median six‐month follow‐up, there have been no episodes of rejection or opportunistic infections. All transplants are currently functioning. Two patients developed urosepsis, one post‐transplant diabetes. Two patients required reoperation and ureteric reimplantation for ureteric leakage.Conclusion  ABO incompatible transplantation can be performed without excessive immunosuppression and with low morbidity. Preservation of the spleen reduces operative risk, post‐operative complications and the added vulnerability to infection.
TN09 HEPATIC EPITHELOID HAEMANGIOENDOTHELIOMA: TWO CONTRASTING CASES
Authors: Stewart G. J. , Crawford M. D. 
Published: April 2007

Epitheloid Haemangioendothelioma of the liver is a rare mesenchymal tumour the recommended treatment of which is either liver resection or hepatic transplantation, if diffuse without metastases. The Australian National Liver Transplant Unit, Sydney has assessed and treated 2 patients with this tumour found to be limited to the liver after extensive investigation.The first case was a 43‐year‐old woman at the time of her operation in 1990. She underwent liver transplantation for a solitary biopsy proven right anterior hepatic lobe haemangioendothelioma. She has been routinely followed up for 16 years and remains recurrence free at last review.The second case was operated upon in 2004. This 59 years old woman present with an incidental radiological finding of multiple biopsy proven Epitheloid Haemangioendothelioma, limited to the right hepatic lobe and anatomically considered resectable. A right hemi‐hepatectomy was performed, however an addition wedge resection of a non‐radiologically recognised deposit in segment III was required. Resection was planned on the basis that no evidence of liver function impairment was evident and so an extended period on the transplantation waiting list might be anticipated. It was also believed that resection would not preclude latter listing for transplantation. Suitability of the tumour for this approach was suggested by low tumour activity on PET scan. This patient has been regularly reviewed for over 3 years with no evidence of recurrence.We will review our experience of this neoplasm in relation to the literature surrounding its management in the liver.
TS14P MANAGING AN EMERGING TRAUMA EPIDEMIC IN AUSTRALIA: ABDOMINAL STAB WOUNDS
Authors: Rozen W. M. , Ma E. H. , Jones I. T. , Judson R. T. 
Published: April 2007

Purpose  The incidence of abdominal stab wounds treated at the Royal Melbourne Hospital has noticeably increased over the 12 month period to March 2006, mirroring an increase in penetrating abdominal trauma throughout many Australian trauma centers. Management protocols for abdominal stab wounds are still contentious. The current study quantifies the increase in stab wounds at the Royal Melbourne Hospital over a 24 month period and analyzes the management and investigative modalities utilized.Methodology  A review of the Trauma Unit of the Royal Melbourne Hospital was performed for the period of March 20th 2004 until March 20th 2006. All anterior abdominal stab wounds were collated for the site of injury, investigations performed on admission, results of investigations, operations performed, and findings at operation.Results  There were 4244 emergency trauma presentations over the 24 months period between March 20th 2004 and March 20th 2006. The second 12 month period showed a 21.5% increase in overall trauma admissions and a 91.3% increase in anterior abdominal stabbings. The percentage of stab wounds treated conservatively fell by 21.8%, with the percentage of laparotomies increasing by 14.2%. Almost 30% of all patients undergoing surgery had no visceral injury at operation. Twenty CT scans were performed preoperatively, with a sensitivity of 79% and specificity of 100%.Conclusion  Abdominal stab wounds treated at Royal Melbourne Hospital have substantially increased over the past 12 months. Whilst management is still contentious, a management protocol for anterior abdominal stab wounds is proposed, outlining the role of CT scanning, conservative management, laparoscopy and laparotomy
TS18P POST INJURY MULTIPLE ORGAN FAILURE: THE AUSTRALIAN CONTEXT
Authors: Dewar D. C. , Balogh Z. , Mackay P. 
Published: April 2007

Background  The epidemiology of post‐injury multiple organ failure (MOF) is reported to go through changes during the last 15 years. The purpose of this study is to describe the epidemiology of post‐injury MOF in Australia.Methods  A 12‐month prospective epidemiological study was performed in a Major Trauma Service. Demographics, injury severity (ISS), physiological, MOF status and outcome data was prospectively collected on all trauma patients who met inclusion criteria (ICU admission; ISS > 15; age > 18, AIS head <3 and survival >48 hrs). MOF was defined by the Denver MOF score. Data are presented as % or Mean+/−SEM. Univariate statistical comparison was performed (Student t‐ and X‐square tests), p < 0.05 was considered significant.Results  Twenty‐five patients met inclusion criteria (Age 39+/−5, ISS 27+/−3, Male 60%), three patients (12%) developed MOF. The maximum MOF score was 5.7 +/−1, with duration of 2.3+/−0.7 days. Two patients had respiratory and cardiac failure, while one patient had failure of respiratory, cardiac, hepatic and renal systems. All MOF patients survived. MOF patients tend to have longer ICU stays (18+/−5.5 vs 7+/−0.8 p = 0.17), were older (54+/−17 vs 38+/−5 p = 0.4). None of the previously described independent predictors (ISS, base deficit, lactate, transfusions) were different when the MOF patients were compared with the non‐MOF patients.Conclusion  MOF is not as significant a cause of late trauma death as previously reported internationally. Our preliminary data challenges the timeliness of the 10‐year‐old independent predictors of post‐injury MOF. The epidemiology, the clinical presentation and the independent predictors of post‐injury MOF requires reassessment for the Australian context.
TS19P STUDY OF THE PATTERN OF INTRA‐ABDOMINAL SOLID ORGAN INJURY – A FIVE‐YEAR CENTRAL AUSTRALIA EXPERIENCE
Authors: Wun L. P. S. , Jacob J. , Boseto F. 
Published: April 2007

Purpose  This study aimed to evaluate the pattern of solid intra‐abdominal organ injuries in Central Australia, with focus on the mechanism of injury, Injury Severity Score (ISS), distribution of injury, role of surgical intervention and their outcome. It aimed to assess if difference exists in the above perimeters between the indigenous and non‐indigenous population.Methodology  This is a retrospective analysis of a selected group of patients as identified by ICD Codes. Database has been created for patients admitted with renal, pancreatic, hepatic and splenic trauma over a five‐year period (2001–2005). Data on demographics, mechanism of injury, distribution of injury, length of stay and ISS has been collected.Results  Seventy‐one patients has been identified, with 51 (72%) indigenous and 20 (28%) non‐indigenous. 29 patients (41%) were involved in a Motor Vehicle Accident and 33 (46%) were assaulted. There is no statistical difference with the distribution of injury and ISS amongst indigenous and non‐indigenous populations. However there appears to have a higher incidence of surgical intervention associated with the indigenous group (28.8% versus 12.5%). This may be explained by the compliance rate as 29.4% of indigenous patients left against medical advice as compared with 0% with the non‐indigenous group.Conclusion  The mechanism, pattern and severity of injury appear to be comparable amongst the indigenous and non‐indigenous population in Central Australia. However there is a difference in their incidence of surgical intervention. ISS may not be as useful in prediction for need for intervention in this group and a different approach to trauma management may need to be tailored to this population.
TS20P LAPAROSCOPIC REPAIR OF TRAUMATIC DIAPHRAGMATIC HERNIAE: A CASE PRESENTATION AND SYNTHESIS OF THE LITERATURE EXPERIENCE
Authors: Chong S. , Adams D. , Rahman H. 
Published: April 2007

Purpose  Traumatic diaphragmatic herniae are an uncommon sequelae of abdominal trauma which present a significant diagnostic challenge, especially when unaccompanied by other intraabdominal injuries necessitating exploratory laparotomy. Laparoscopic repair is a relatively new and uncommon procedure, with the literature consisting almost entirely of isolated case reports and small case series. We present one of our own cases, and perform a quantitative analysis of the combined literature experience to date.Methodology  Cases reports of laparoscopic repair of traumatic diaphragmatic herniae were identified by a Medline literature search. Clinical findings, technical decisions and outcomes were correlated via database.Results  Data from 50 cases was available. There was no common standard method of repair although the majority (31/50) were accomplished without the use of mesh. The major complication rate was 4%, the overall complication rate was 16%. Defects greater than 10cm long were associated with a 41% rate of open conversion, versus 0% if less than 10cm. There were no recurrences described.Conclusion  Laparoscopic repair of traumatic diaphragmatic herniae enjoys a low rate of major complications, whilst avoiding the morbidity of open repair. Several technical points remain open to operator preference, and we invite discussion regarding the merits of each.
TS03 RETROHEPATIC VENA CAVA INJURY REMAINS A CHALLENGE TO TRAUMA SURGEONS
Authors: Collet e Silva F. S. , Bardella R. , Porta R. M. , Poggetti R. S. , Birolini D. 
Published: April 2007

Although uncommon, and despite the modern in diagnostic tools and therapeutic alternatives, retrohepatic and main hepatic veins injury remains associated with high mortality rate. Preoperative diagnosis is uncommon, and bullet trajectory may be a helpful sign in penetrating trauma patients.Patients and Methods  Hospital records of patients sustaining retroheptic vena cava (RHVC) injury were retrospectively reviewed as to diagnosis, associated injuries, injury characteristics, surgical management, and outcome, last ten years.Results  Eight male, 17 to 45 (mean 27.5) years‐old patients sustaining RHVC injury were reviewed. Mean trauma indexes for the 8 cases were: ISS 36.6, RTS 7.55 and TRISS 89.0; and for the group who died: ISS 41.6, RTS 7.18, and TRISS 80.5. Two patients had sustained blunt trauma (one died), and six had penetrating injuries (two died). The injury diagnosis was achieved during surgery in all cases. A transfixing RHV injury occurred in 4 (50% of the) patients, and was found in all the 3 patients who died. An atriocaval shunt was employed in four patients, 3 of them had with transfixing injury with two deaths. The number of associated injuries was higher in the patients who died. Overall mortality rate was 37.5%.Comments  Despite advances in image diagnosis, injuries to RHVC are frequently diagnosed during surgery. Tangential injuries were managed with direct approach and sutures, and to control blending in transfixing injuries, were managed with atriocaval shunts, before suture.Conclusion  Despite improvements in its diagnosis and management, RHVC injuries remain with a high mortality rate, mainly when transfixing, and associated with numerous associated injuries.
TS04 THE EPIDEMIOLOGY OF PELVIC FRACTURES: THE WHOLE PICTURE
Authors: Mackay P. , King K. , Mackenzie S. , McDougall D. , Evans J. , Balogh Z. 
Published: April 2007

Purpose  The comprehensive describtion of the epidemiology of pelvic ring fractures (PRF) including high‐energy PRF, low‐energy PRF and those who die during the prehospital phase (pre‐H).Methods  12‐month prospective population based study was performed in a trauma system with one Level‐1 trauma centre and seven referring hospitals (population: 0.6 million). Data were collected on all PRF from the trauma system including high‐energy, low energy fractures and pre‐H deaths with PRF. Patient demographics, injury severity score (ISS), mortality (%) and PRF‐related mortality were recorded prospectively. All high‐energy deaths had autopsy at the same forensic pathology department. Data presented as percentages (%) or mean +/− SEM.Results  During the 12‐month period 138 patients suffered PRF (45% male, 59+/−2 years, ISS 20+/−2, 21% mortality and 8% PRF‐related mortality). Sixty‐four % of the low‐energy and 92% of the high‐energy patients were transferred directly to the trauma center. There were 57 high‐energy (71% male, 41+/−3 years, ISS 23+/−3, 14% mortality, 7% PRF‐related mortality) 63 low‐energy (20% male, 81+/−1 years, ISS 6+/−1, 5% mortality, 2% PRF‐related mortality) and 18 pre‐H died patients with PRF (47% male, 41+/−6 years, ISS 61+/−4, 100% mortality, 33% PRF‐related mortality). PRF‐related mortality was always due to bleeding.Conclusions  The majority of PRF‐related mortality occurs pre‐H. Half of the multiple‐injured high‐energy PRF patients still die because of the pelvic bleeding. Further preventive measures and optimization of the care of PRF patients is required. Trauma centre admission of 2/3 of the low‐energy PRF is a significant load and should be further investigated in an inclusive trauma system.
VS11 OPERATIVE APPROACH FOR THORACIC OUTLET SYNDROME
Authors: Roberts‐Thomson J. H. , Lamont P. M. 
Published: April 2007

Purpose  Thoracic Outlet Syndrome has been described for nearly 200 years. Its development is interesting and will be presented. A limited series from our institution is presented with emphasis on vascular complications of this problem.Methodology  A Pub. Med engine search over the last 30 years using the titles thoracic outlet syndrome and first rib resection was done.106 articles were studied. Our 6 cases of vascular ramifications of thoracic outlet syndrome are presented.Results  Only 1 randomised trial comparing diffferent approaches has been reported so management has been controversial. Incidence of subclavian and axillary vein thrombosis has increased. We have found the axillary approach for this condition of Paget Schroetter syndrome difficult and access made easier by using an infraclavicular or combined with a supra clavicular approach.Conclusions  As this condition is uncommon most centres will have only limited experience. A combined endovascular and surgical decompression yields best results.
VS16P OUTCOMES OF ARTERIOVENOUS FISTULA FOR VASCULAR ACCESS
Authors: Banerjee N. , Hill A. , Bourchier R. 
Published: April 2007

Introduction  Vascular access for chronic haemodialysis persists as a surgical challenge. The development of the radiocephalic arteio venous fistula in 1966 by Brescia was a milestone in vascular access surgery. There has been a move away from the use of prosthetic due to the associated complications.A decision was made at this institution to use autologous vein in all cases recognising the consequence of using marginal veins.Aim  To determine the Outcomes of all Radiocephalic, Bracheocephalic and Transposition arterio venous fistulae.Method  A retrospective study by review of the case notes was carried out in March 2006.All renal access procedures performed between 6/03 and 6/05 were reviewed.In the new native fistulas formed during this time, the following end points were sought: Primary, secondary and functional patency at 24 hrs. 6 weeks, 6 months and 1 year.Results  Life table analysis of the patency outcomes showed that Percentage primary patency rates for Radiocephalic and Bracheocephalic fistulae were 71% and 74% at 1 year respectively. Subgroup analysis of females, diabetics and those with BMI > 30 showed diabetics composed >40% of patients and patients with BMI >30 was 29%. Of these two subgroups primary patency rates were comparable to the whole group.Conclusion  The population studied was different to those in other parts of the world. FavourablePrimary patency rates were obtained for this challenging group of patients.
VS18P IS ENDOVASCULAR REPAIR OF RUPTURED ABDOMINAL AORTIC ANEURYSMS CHANGING THE SELECTION CRITERIA FOR INTERVENTION? – A 5 YEAR RETROSPECTIVE AUDIT IN A SMALL TEACHING HOSPITAL
Authors: Arvapalli V. K. , Walker S. , Beasley T. 
Published: April 2007

Purpose  Endovascular repair (EVR) of ruptured abdominal aortic aneurysms (RAAA) holds great promise in the treatment of this usually fatal condition. We aim to demonstrate how the impact of EVR of RAAA has started to alter our practise.Methodology  A retrospective review of all patients presenting with RAA to a small tertiary referral teaching hospital.Results  Between January 2001 and September 2006, 76 patients presented with RAAA. One refused surgery and 26 were treated palliatively, all but one died. Forty four underwent conventional open repair (OR) of RAAA (32 men, mean age 68.3 years) and 5 had EVR (4 men, mean age 78.5 years). All patients who underwent EVR would previously have been declined OR due to medical co‐morbidities. The mean annual 30 day mortality for OR was 57% but this has fallen from 70% in 2002 to 25% in 2006. The 30 day mortality for EVR of RAAA was 0%. Mean hospital stay following OR was 20.4 days and following EVR was 17.5 days but mean ICU length of stay was unchanged at 10 days.Conclusion  Despite recent improvements in survival following OR of RAAA, our initial experience of EVR suggests that we can still do better. Should we be offering this new technology to patients we would previously have declined OR?