bluuebunny/crossref_metadata_2025_split huggingface dataset:
AUGER INJURIES IN THE WIMMERA REGION 1987–95
Authors: Read Katrina O. M. , Campbell Ian A. , Kitchen Graham 
Published: January 2008

Background: Eighteen cases of auger injuries in the Wimmera region of Victoria were treated over 8 years.Methods: The records of auger related injuries presenting to Wimmera Base Hospital from March 1987 to March 1995 were reviewed.Results: Five of these were severe injuries. Sixteen were male farmers. Their fingers were most commonly injured by being caught in the auger flight.Conclusions: Augers have numerous mechanical features which make them one of the most potentially dangerous pieces of farm equipment. This, combined with human error and fatigue, results in significant but preventable morbidity in a hardworking population.
SPINAL EPIDURAL ABSCESS: A REPORT OF NINE CASES AND THE USE OF INTRA‐OPERATIVE ULTRASONOGRAPHY
Authors: Mak K. H. , Au K. K. , Fung K. Y. , Chan Y. W. 
Published: January 2008

Background: Spinal epidural abscess is an uncommon and dangerous lesion. Once neurological complications occur the damage is often irreversible.Methods: The clinical presentation, operative findings, management and follow up of nine cases of spinal epidural abscess were reported. Four patients were diabetic and four others were intravenous drug addicts. The last patient had a history of a protracted stay in an intensive care unit complicated by pneumonia and pleural effusion. Ultrasonography was used intraoperatively to guide and to assess the adequacy of drainage and decompression of the epidural abscess.Results: Multiple level laminectomy was necessary and Staphylococcus aureus was the most common organism cultured. None of the five patients presenting with acute complete paralysis regained neurological function. Two of the four patients with incomplete paralysis were able to walk with an aid.Conclusions: Spinal epidural abscess usually presents late and the prognosis is generally poor. Ultrasound may be useful in determining the extent of the abscess during operation to drain the collection.
PSYCHOLOGICAL ASPECTS OF CHRONIC LOW BACK PAIN
Authors: Sikorski Jerzy M. , Stampfer Hans G. , Cole Rowena M. , Wheatley Allison E. 
Published: January 2008

Background: Patients with chronic low back pain present physicians with diagnostic and therapeutic problems. Physical treatments tend to have low success rates and it is postulated that this may be because low back pain can be a manifestation of abnormal illness behaviour.Methods: A structured prospective study determined the prevalence of somatization in a sample of 131 adult patients with chronic low back pain using the Illness Behaviour Questionnaire (IBQ) and the Modified Somatic Perception Questionnaire (MSPQ). The scores on these psychological questionnaires were compared with the blind interpretation of pain distribution drawings and with the results of a mechanical classification of the patient's symptoms and signs.Results: Fifty‐four per cent of patients had four or more (out of five) abnormal illness indicators. The MSPQ values for the group were significantly above the control values in the literature. Thirty‐two per cent of pain diagrams were thought to be incompatible with an organic cause when assessed by an orthopaedic surgeon and sixty‐two per cent when assessed by a psychiatrist.Conclusions: Psychosocial factors are dominant in the presentation of chronic low back pain in adults and the disorder is not primarily a musculoskeletal one.
LAPAROSCOPIC CHOLECYSTECTOMY AND PREVIOUS ABDOMINAL SURGERY: A SAFE TECHNIQUE
Authors: Patel Manish , Smart Denis 
Published: January 2008

Previous abdominal surgery has been cited as a contraindication to the performance of laparoscopic cholecystectomy. The present paper describes a technique whereby a Hasson cannula was introduced into the right iliac fossa by the open technique, using a method similar to an appendicectomy. The laparoscope was then introduced through this port and the safe introduction of other ports was achieved. Any adhesions were divided at this stage. The laparoscope was then moved to the umbilical port and a conventional laparoscopic cholecystectomy performed.In the series of six patients with upper or upper and lower abdominal scars, no patient suffered a complication or required a conversion to laparotomy. However, the operating time was increased from 75 to 105 min.This method involves open introduction of the primary trocar in an area devoid of adhesions. It was shown to be safe and with this method previous abdominal surgery should not be regarded as a contraindication.
EARLY DISCHARGE AFTER OPEN APPENDICECTOMY
Authors: Lord Reginald V. N. , Sloane David R. 
Published: January 2008

Background: There is increasing pressure on surgeons to minimize the time patients stay in hospital, and there is therefore a need to establish guidelines for reasonable lengths of stay for common operations. This study was conducted to test the feasibility and safety of early discharge after open appendicectomy. In addition, this study was performed to provide standards for open appendicectomy against which the results of laparoscopic appendicectomy can be compared.Methods: A prospective study of all patients having open appendicectomy for suspected acute appendicitis at Liverpool Hospital, Sydney during a 4 month period was undertaken. An early discharge programme was established, with the aim of discharging patients within 48 h of operation in uncomplicated cases. Discharge was allowed when the patient was eating, walking, and had passed flatus. Follow up was with the consultant surgeon at I week postoperatively, and with a community nurse at 2 weeks. Multivariate linear regression, using the number of postoperative hours to discharge as the outcome, was used to analyse the data for the following four factors: age, gender, incision type, and pathology.Results: One hundred and sixteen consecutive patients were enrolled in the study. The median postoperative stay for all patients was 46 h. Perforation of the appendix, use of a midline laparotomy for appendicectomy, and age significantly prolonged hospital stay, but gender had no effect. The main complication was wound infection, which was seen in 7.5% of patients. No patient had a problem directly related to early discharge. A community nurse saw 81% of patients 2 weeks after discharge. Over three‐quarters of the patients seen had returned to full normal activities by 2 weeks, including work or school. Eighty‐eight per cent of patients considered the timing of their discharge ‘good’ or ‘excellent’.Conclusions: Discharge at 2 days after open appendicectomy is both feasible and safe for patients having an unperforated appendix removed through a right iliac fossa incision. Passage of stool is not required prior to discharge. Early discharge is well accepted by patients and may result in financial savings for hospitals where payment is according to Diagnosis‐Related Groups. On the basis of the results of the six randomized controlled trials comparing laparoscopic and conventional open appendicectomy published to date, and on the results of this study, the authors conclude that laparoscopic appendicectomy should not yet be considered the ‘procedure of choice’, and surgeons are justified in performing appendicectomy by either method.
A DECADE OF GASTROSCHISIS IN THE ERA OF ANTENATAL ULTRASOUND
Authors: Nicholls Eric A. , Ford W. D. Andrew , Barnes Katherine H. , Furness Margaret E. , Hayward Christina 
Published: January 2008

Background: Gastroschisis is an uncommon condition in which viscera protrude at the base of the umbilical cord. To investigate the possible relationships between antenatal ultrasound findings, patient demographics, smoking, alcohol consumption and this condition, 21 causes are reviewed.Methods: The medical records and antenatal ultrasounds of 21 children diagnosed with gastroschisis at the Adelaide Children's Hospital between 1 January 1985 and 31 December 1992 were reviewed.Results: Antenatal ultrasound was employed in 15 cases, and the diagnosis was accurately made in 13 (86.7%) of these. There were 17 live births, two elective terminations and two pre‐term abortions. Seven of the 21 cases had associated anomalies. The anomalies included five atresias, a ventricular septal defect (VSD), and a dislocated gall‐bladder. Postoperative complications (which included one death) occurred in seven of the 17 patients. Bowel dilatation or thickening was first detected on five ultrasound examinations performed before 21 weeks' gestation, and four ultrasounds after 21 weeks. The nine cases with bowel changes on ultrasound were associated with a high atresia rate and a longer hospital stay, but not with an increased complication rate. Maternal race, parity, and alcohol consumption were not associated with increased risk of fetal gastroschisis. All mothers were under 27 years of age. There were nine mothers who smoked during pregnancy and a disproportionate number of mothers who lived outside the metropolitan area with gastroschisis‐affected offspring.Conclusions: Bowel changes seen on antenatal ultrasound increase the chances of intestinal atresia and longer hospitalization. Smoking during pregnancy may be associated with an increased risk of gastroschisis.
WHITE BLOOD CELL COUNTS IN PATIENTS UNDERGOING ABDOMINAL SURGERY
Authors: Blennerhassett L. , Hall J. L. , Hall J. C. 
Published: January 2008

Background: The role of pre‐operative white blood cell counts (WBCC) in patients with an acute abdomen is contentious.Methods: This study documents the association between pre‐operative WBCC and the extent of intraperitoneal inflammation at the time of surgery in a heterogeneous group of 1166 patients undergoing abdominal surgery.Results: WBCC failed to adequately discriminate between groups of patients with varying degrees of intraperitoneal inflammation. For example, only 31% (37/118) of the patients with either free pus or an abscess within the peritoneal cavity had a WBCC > 15.0 × 109/L.Conclusions: There is a need to replace the WBCC with more powerful predictors of inflammation within the peritoneal cavity.
INTRA‐OPERATIVE IMPLANT BRACHYTHERAPY IN THE MANAGEMENT OF SOFT‐TISSUE SARCOMAS
Authors: Burmeister B. H. , Dickinson I. , Bryant G. , Doody J. 
Published: January 2008

Background: The management of localized soft‐tissue sarcomas remains complex. This is a retrospective review of a single institution experience with manual afterloaded brachytherapy following intra‐operative implantation of the tumour bed during surgery. Methods: Twelve patients over a 3‐year period had resection for localized soft‐tissue sarcomas and desmoids with insertion of intra‐operative brachytherapy implants combined with resection for localized soft‐tissue sarcomas. Manual afterloading of the implant with iridium wires was performed postoperatively in all patients. The low dose rate brachytherapy dose varied from 13 to 20 Gy. Supplementary external beam radiation was administered pre‐operatively or postoperatively to bring the total dose of adjuvant irradiation to 60–65 Gy. Results: After a median follow‐up period of 29 months, the 3‐year local disease‐free survival rate was 63%. The 3‐year actuarial survival rate was 83%. There were no failures within the high‐dose region of the implant, although two patients had locoregional failures adjacent to the tumour bed at the edge of the radiation field. Three patients developed distant metastases. Side effects were noted in five patients. Wound breakdown and delayed wound healing occurred in two patients. One patient required an amputation as a result of chronic non‐healing and wound pain. Pathological fractures occurred in two patients. Those patients who did not develop wound breakdown had good cosmetic and functional outcomes. Conclusion: Intra‐operative implantation of the tumour bed in combination with tumour resection for soft‐tissue sarcomas results in a high degree of local control with acceptable complications. This modality offers the patient a high chance of avoiding a more radical surgical procedure such as limb amputation.
SURGICAL TREATMENT OF BREAST CANCER IN NEW SOUTH WALES 1991, 1992
Authors: Adelson Pamela , Lim Kim , Churches Tim , Nguyen Ru 
Published: January 2008

Background: The purpose of this study was to examine existing data on women diagnosed with breast cancer in New South Wales in 1991 and 1992 and to describe surgical treatments received on an inpatient basis. Methods: Analyses were based on the linkage of two databases: the New South Wales Central Cancer Registry and the New South Wales Health Department's Inpatient Statistics Collection. Data were limited to women who were resident and treated in New South Wales. Main analyses were restricted to definitive surgical procedures. Results: Thirty‐six per cent of women treated surgically for breast cancer in 1991 had breast‐conserving therapy. This had increased to 39% in 1992. There were substantial geographical variations in the use of breast‐conserving therapy in New South Wales which could not be explained by patient characteristics. Age, degree of spread at diagnosis, and area health service/health region were all found to have an independent association with the probability of having a mastectomy. Conclusions: Women with a localized degree of spread living in non‐metropolitan areas (Health Regions) were almost twice as likely to have a mastectomy as compared with similar women who were resident in metropolitan areas (Area Health Services). The concentration of radiotherapy services may have contributed to the urban/rural variation in breast‐conserving therapy in New South Wales, but it is also likely that some of the variations that were observed may be a reflection of the failure of clinicians to use best current practice.
THE ‘UROGENITAL DIAPHRAGM’, EXTERNAL URETHRAL SPHINCTER AND RADICAL PROSTATECTOMY
Authors: Kaye Keith W. , Milne Nick , Creed Kate , Werf Barbara van der 
Published: January 2008

Background: The present study was performed to determine whether a ‘urogenital diaphram’ exists, to examine the true nature of the striated external urethral sphincter and to evaluate whether the standard technique for radical prostatectomy damages the external sphincter. Methods: Fifty radical prostatectomies were performed using optical magnification and the dorsal bunching technique, and the external sphincter was carefully examined. Ten human cadavers and one 5‐year‐old baboon were dissected with longitudinal (sagittal) and transverse sections being taken through the prostate apex, membranous and bulbar urethrae. During the standard technique for dorsal vein control during radical prostatectomy, the tissue incorporated within the ligature was examined for striated muscle. Results: No ‘urogenital diaphram’ could be demonstrated in any human or baboon tissue. The striated external urethral sphincter is a cylinder of muscle surrounding the membranous urethra, extending from the perineal membrane to the prostate and continuing over the prostate as part of the anterior fibromuscular stroma. Striated muscle was present in the ligated material from the dorsal venous complex. Conclusions: The ‘urogenital diaphram’ is a myth. The standard technique of radical prostatectomy significantly damages the external sphincter.
THE PRACTICE OF CAROTID ENDARTERECTOMY IN AUSTRALASIA
Authors: Frydman Gary M. , Codd Catrina A. , Cavaye Douglas M. , Walker Philip J. 
Published: January 2008

Background: Carotid endarterectomy (CEA) is a frequently performed surgical procedure and there are variations in the preoperative, operative and postoperative management related to this operation. Methods: Questionnaires were sent to all 191 members of the Division of Vascular Surgery, Royal Australasian College of Surgeons, and the Australasian Chapter of the International Society of Cardiovascular Surgery. Results: The questionnaire was returned by 179 surgeons (94%). One hundred and fifty‐nine were vascular surgeons, of whom 139 perform CEA. Most surgeons reported performing more CEA than 5 years previously. Surgery for asymptomatic carotid stenosis was performed by 78% of surgeons at the time of the survey. Routine carotid angiography is performed pre‐operatively for symptomatic patients by 61% of surgeons and for asymptomatic patients by 56%. Intra‐operative shunting is used routinely by 37% of surgeons, selectively by 58% and never by 5%. Arteriotomy patch closure is performed routinely by 16%, usually by 30%, rarely by 52% and never by 3%. The favoured patch material is Dacron 39%, PTFE 19%, ankle long saphenous vein (LSV) 22%, thigh LSV 18% or other materials 2%. Compared to their practice 5 years previously, arterial patch closure is used more often by 42% of surgeons, the same by 51% and less by 7%. Postoperatively, patients are nursed mainly in intensive care (34%) or a high‐dependency unit (33%). Conclusions: The practice of CEA by Australasian vascular surgeons reflects the recent trends reported in the world literature. Most Australasian surgeons perform CEA for asymptomatic disease. Forty per cent are performing CEA on the basis of duplex scanning alone. There is a trend towards increased use of patch closure. Most patients are managed in intensive care or high‐dependency units.
LAPAROSCOPIC‐ASSISTED COMPARED WITH OPEN TOTAL COLECTOMY IN TREATING SLOW TRANSIT CONSTIPATION
Authors: Ho Yik‐Hong , Tan Margaret , Eu Kong‐Weng , Leong Adrian , Choen Francis Seow 
Published: January 2008

Background: Total colectomy is the procedure of choice when slow transit constipation (STC) can be confidently diagnosed. A laparoscopic‐assisted technique (LTC) may be potentially advantageous over traditional open technique (OTC) in the treatment of this benign condition. Methods: A historical control (non‐randomized) study was performed on patients diagnosed to have STC after clinical, anorectal physiologic and transit marker studies. All earlier consecutive patients underwent OTC and the latter consecutive patients underwent LTC. The intra‐operative time, blood loss, postoperative ileus recovery, duration of hospitalization and complications were recorded. A bowel function and patient satisfaction questionaire was administered on follow‐up. Results: Twenty‐four of 411 patients were found to have STC; 17 (2 men, 15 women; mean age, 40 (standard error of mean [SEMI 5) years) underwent OTC and 7 (2 men, 5 women; mean age, 39.5 (SEM 6) years) underwent LTC. There were significant improvements in the stool frequency, need for assisted evacuation and abdominal distension (P < 0.05) after both procedures; 96% were fully satisfied with the resulting bowel function. However, OTC patients were less satisfied with the cosmetic outcome (P < 0.05). Intra‐operative time for LTC was longer by a mean 74 min (P < 0.05). Postoperative blood loss, recovery of ileus and hospitalization time were the same in both groups. There were no deaths. The complication rates were 43% for LTC and 24% for OTC. The predominant complication was bowel obstruction for which two patients (both OTC) required adhesiolysis. Conclusions: Both OTC and LTC improve bowel function for STC; LTC gives a better cosmetic result, but takes longer to perform.
PREDICTING POOR OUTCOME IN PERFORATED PEPTIC ULCER DISEASE
Authors: Evans J. P. , Smith R. 
Published: January 2008

Background: Despite modern medications for peptic ulcers, patients frequently require emergency surgery for complications of ulcer disease. Many of these patients have coexisting medical problems which not only predispose to perforated ulcer disease, but also influence the clinical outcome. This study reviews the outcome of a group of patients with perforated ulcer disease and examines the influence of a range of comorbidity factors on the outcome. Methods: A retrospective chart review of all cases of perforated peptic occurring over a period of 9 years. Results: One hundred and forty‐nine perforated peptic ulcers in 147 patients were diagnosed between 1987 and 1996. Coexisting malignancy, use of immunosuppressives or corticosteroids, pre‐operative shock and admission to intensive care were all significantly associated with reperforation by univariate analysis. However, logistic regression analysis indicated that none of these factors independently predicted reperforation which, therefore, occurs as a multifactorial event with all the above factors contributing.Death from perforated ulcer disease was related to pre‐operative shock, malignancy, admission to intensive care and reperforation when examined by univariate analysis. Furthermore, logistic regression analysis showed that coexisting malignancy and reperforation were significant predictors of mortality. Conclusions: Perforated peptic ulcer disease remains a frequent clinical problem in patients with short dyspeptic histories, who may or may not have been using ulcerogenic medications. It is a significant cause of morbidity and mortality among an often aged and otherwise unwell group of patients. Patients with underlying malignant disease, who may be immunosuppressed with corticosteroids or cytotoxics, are at increased risk of dying from perforated ulcer disease. Reperforation of an ulcer, following simple closure or conservative treatment, is also highly predictive of increased mortality.
THE MANAGEMENT OF COLORECTAL PERFORATION AND PERITONITIS
Authors: Isbister William H. 
Published: January 2008

Background: Surgical outcomes in patients presenting with colonic perforation or peritonitis tend to be poor. This study was undertaken to determine outcomes in such patients at a time before multiple re‐laparotomies were performed. Methods: Retrospective analysis of computer records of all patients presenting acutely to the University Surgical Unit (Wellington School of Medicine) with colonic perforation or peritonitis over a 15‐year period. Results: Seventy‐three patients, 33 males and 40 females were admitted with either perforation or localized peritonitis of colorectal origin. Of these, 78% were managed as emergencies, but six were admitted electively and found incidentally. Consultant surgeons performed surgery slightly more frequently than registrars. Two patients were managed non‐operatively. Forty‐one percent received peri‐operative blood transfusion and 22% peri‐operative total parenteral nutrition. The majority of patients presented with either peritonitis or free perforation in association with diverticular disease. The site of perforation was either ileocolic or sigmoid colonic in the majority of patients. Hartmann'operation was the most commonly performed resection. Respiratory, urinary and wound infections were the most commonly observed postoperative complications. Two patients developed anastomotic leaks (6.3%). The overall persistent intra‐abdominal infection rate was 5.5%. Seven patients died following surgery. Conclusions: Resection of the perforated bowel is mandatory and this should be followed by anastomoses in the case of right‐sided lesions and a Hartmann'operation or resection, colostomy and mucous fistula in distally situated lesions.