bluuebunny/crossref_metadata_2025_split huggingface dataset:
SO01 NEOADJUVANT: RECTAL CANCER
Authors: Robinson B. A. 
Published: April 2007

Neoadjuvant therapy is given before surgery to improve resectability, local control and/or survival. Post‐operative radiation therapy for locally advanced rectal cancer has been long accepted, and since 1990 adding fluorouracil (5FU) chemotherapy became the NIH standard. However, trials then showed that pre‐operative radiotherapy followed by surgery improved local control over surgery alone, but had a less consistent effect on overall survival. The German trial (Sauer, NEJM, 2004, 351:1731) showed a 5 year local relapse rate of 6% for pre‐operative chemo‐radiotherapy and 13% for post‐operative chemo‐radiotherapy for T3 or T4 or node‐positive rectal cancer treated by TME. The EORTC 22921 trial (37% had TME) showed a similar reduction in local recurrence whether 5FU/leucovorin chemotherapy was given with pre‐operative radiotherapy, after pre‐operative radiotherapy plus surgery, or both (Bosset, NEJM, 2006, 355:1114). Trials show increased rates of complete pathological remission, increased acute toxicity, but no consistent effects on sphincter preservation rates or overall survival when chemotherapy is combined with pre‐operative radiation.Many questions remain. The TROG/AGITG trial compares pre‐operative radiotherapy as a short course (5 Gy X 5♯) or long course with chemotherapy (50.4 Gy plus 5 FU infusion), with accrual just completed. Ongoing phase III trials explore capecitabine, adding other drugs to 5 FU, and post‐operative adjuvant chemotherapy.Neo‐adjuvant pre‐operative radiation with concurrent chemotherapy, unless contra‐indicated by comorbidity, has become widely accepted for T3 or T4 or node‐positive rectal cancer based on MRI staging. Individual patient care is best planned by a multidisciplinary team.
SO12P COMBINED CYTOREDUCTIVE SURGERY AND PERIOPERATIVE INTRAPERITONEAL CHEMOTHERAPY IN THE TREATMENT OF PERITONEAL MESOTHELIOMA
Authors: Sim J. , Yan T. D. , Morris D. L. 
Published: April 2007

Purpose  Australia has the highest incidence of mesothelioma worldwide. Compared with traditional treatments using systemic chemotherapy, the combined cytoreductive surgery (CRS) with perioperative intraperitoneal chemotherapy (PIC) has shown improved survival.Methodology  Fifteen consecutive patients with peritoneal mesothelioma underwent CRS and PIC at the St. George Hospital, Sydney. Clinical and treatment‐related data were prospectively collected and reported. The morbidity and mortality rates and overall median survival were evaluated to assess the safety and efficacy of CRS and PIC in the treatment of peritoneal mesothelioma.Results  There were 10 male and 5 female patients. The median age was 55 years old (range 35–72). The median follow‐up was 12 months (range 6–50). Thirteen patients were surveyed regarding asbestos exposure, in which 7 reported a definite asbestos exposure, 3 reported working in high risk occupations and 3 reported minimal exposure risk. The mean operating duration was 9.6 hours. Rate of re‐operation was 7% and mean hospital stay was 23 days. The morbidity and mortality rates were 36% and 7% respectively, with an overall median survival of 86 months (range 1–86). The 1‐, 2‐ and 3‐year survivals were 80%, 69% and 55% respectively.Conclusion  CRS combined with PIC is a treatment option for peritoneal mesothelioma that confers improved survival, when compared with historical controls using systemic chemotherapy.
SO14P PERIOPERATIVE OUTCOMES OF CYTOREDUCTIVE SURGERY AND PERIOPERATIVE INTRAPERITONEAL CHEMOTHERAPY FOR NON‐APPENDICEAL PERITONEAL CARCINOMATOSIS FROM A PROSPECTIVE DATABASE
Authors: Yan T. D. , Sugarbaker P. H. 
Published: April 2007

Purpose  Cytoreductive surgery and perioperative intraperitoneal chemotherapy has expanded its application in the management of peritoneal carcinomatosis from gastrointestinal and ovarian malignancies. An accurate assessment of perioperative outcomes is crucial for integration of this combined procedure into clinical practice.Methodology  A prospective study of 80 patients undergoing the combined treatment for non‐appendiceal peritoneal carcinomatosis was conducted. Forty‐seven adverse events by 8 organ‐systems were rated from Grade I to IV with increasing severity. Grade I morbidity was self‐limiting; Grade II required medical treatments; Grade III required an invasive intervention; and Grade IV required returning to the operating room or intensive care management.Results  One patient (1.3%) died postoperatively. Postoperative adverse events affected genitourinary system (38%), haematological system (31%), gastrointestinal system (25%), infection (20%), intravenous catheters status (15%), pulmonary system (14%), cardiovascular system (11%), and neurological system (4%). Thirty‐six patients (45%) experienced 49 Grade III adverse events. Six patients (8%) experienced 8 Grade IV adverse events. More than 4 peritonectomy procedures (p = 0.010), and length of hospital stay of more than 21 days (p = 0.007) were strongly associated with Grade III and/or Grade IV morbidity.Conclusions  The morbidity and mortality rates after the combined treatment for non‐appendiceal peritoneal carcinomatosis were within the acceptable range of surgical treatments for other gastrointestinal cancers. A standardized prospective database is required for an accurate assessment of perioperative outcomes.
SO16P MULTIDISCIPLINARY CANCER CARE IN AUSTRALIA: AN AUDIT OF CURRENT UPTAKE
Authors: Wilcoxon H. , Evans A. , Goodwin H. , O’Brien J. , Zorbas H. , Luxford K. 
Published: April 2007

Multidisciplinary care (MDC) has been shown to improve care and outcomes for cancer patients and is incorporated into national and state/territory clinical practice guidelines, frameworks and plans across Australia. The National Breast Cancer Centre Principles of Multidisciplinary Care provide a flexible framework for the implementation of MDC. However, while there has been a considerable focus on MDC in breast cancer there is anecdotal evidence that the wider uptake of MDC is limited.The NBCC has undertaken a national audit of MDC activity across five tumour streams: breast, gynaecological, lung, colorectal and prostate cancers. The aim of the audit was to provide a snapshot of MDC activity in Australia across a range of health service delivery settings, to identify areas or gaps where implementation strategies could be targeted to increase MDC uptake. The audit was timed to precede the introduction of a Medicare Benefit Schedule item to support specialists attending MDC meetings.A random sample of 420 hospitals, stratified by state/territory, hospital type (public/private) and geographic area (metropolitan/regional) were invited to nominate hospital staff to participate in a telephone survey about MDC activity for each of the five tumour streams. The survey investigated both practical and qualitative aspects of MDC practice based on the Principles of Multidisciplinary Care. Within two states the survey was administered through collaboration with state‐based health departments.The national data was analysed by tumour stream, hospital type and geographical area. Key results and outcomes relevant to surgeons will be presented.
SO02 SYNOPTIC REPORTING OF BREAST IMAGING: AN OPPORTUNITY TO IMPROVE BREAST CANCER CARE
Authors: Mann B. , Zorbas H. , Goodwin H. , Nehill C. 
Published: April 2007

A scoping study of breast imaging reporting in July 2006 by the National Breast Cancer Centre (NBCC) revealed that synoptic reporting has not been widely implemented in Australia. The 2002 NBCC publication Breast imaging: a guide for practice recommended the use of a breast imaging synoptic report.A synoptic report contains a summary of essential information in a checklist format with standard language, descriptions and classification system (i). Synoptic reporting may improve the content and completeness of reports, reduce the risk of misinterpretation of findings, improve communication between referring clinicians and radiologists and facilitate the transfer of information to databases for quality improvement activities and audit (i).A breast imaging synoptic report helps clinicians and patients by assisting in tracking individual lesions, ensuring the inclusion of mammographic and ultrasound characteristics of lesions, offering one classification per lesion and a combined imaging diagnosis.As a result of the scoping study, the breast imaging synoptic report has been revised by a multidisciplinary working group to ensure acceptability and applicability to radiologists, referring clinicians and end users. A number of strategies have been identified to assist the implementation of the revised NBCC breast imaging synoptic report and standard classification system.Surgeons as referrers and end users, play an integral role in advocating and promoting the use of synoptic reporting in breast imaging.(i) National Breast Cancer Centre. Breast imaging: a guide for practice. Camperdown, NSW: National Breast Cancer Centre, 2002.
SO03 CRITICAL ANALYSIS OF TREATMENT FAILURE FOLLOWING COMPLETE CYTOREDUCTIVE SURGERY AND PERIOPERATIVE INTRAPERITONEAL CHEMOTHERAPY FOR PERITONEAL DISSEMINATION FROM APPENDICEAL MUCINOUS NEOPLASMS
Authors: Yan T. D. , Bijelic L. , Sugarbaker P. H. 
Published: April 2007

Purpose  The objective of this data analysis was to study treatment failure after complete cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) for peritoneal dissemination from appendiceal mucinous neoplasms.Methodology  Prior to June 2006, 402 patients with peritoneal dissemination from appendiceal mucinous neoplasms underwent complete cytoreduction and PIC at the Washington Cancer Institute. Patient characteristics, pathologic features and treatment‐related data were obtained from a prospective database. Survival analyses were performed using Kaplan‐Meier method and Cox Regression model.Results  After a median follow‐up of 66 months, the 5‐ and 10‐year overall survival rates for the entire 402 patients were 90% and 85%, respectively. The 5‐ and 10‐year progression‐free survival rates were 70% and 67%, respectively. Disease progression was the only independent risk factor for a reduced overall survival. One hundred and eleven patients (28%) developed progressive disease. Of these, 98 patients underwent second‐time and 26 patients third‐time CRS and PIC. Complete cytoreduction after repeat surgery was the only independent prognostic factor for an improved survival. The most common sites of treatment failure were on the small bowel and in the pelvis.Conclusions  The present study reported the patterns of treatment failure after complete cytoreduction and demonstrated that a disease‐free state is important for long‐term survival in peritoneal dissemination from appendiceal mucinous neoplasms. Repeat complete cytoreduction should be pursued when possible and is associated with an improved overall survival in patients with recurrent disease.
SO05 THE NATURE OF NEARBY LYMPHATICS DICTATES WHETHER A VASCULAR ENDOTHELIAL GROWTH FACTOR‐D (VEGF‐D) INDUCES TUMOR LYMPHATICS AND METASTASIS
Authors: Shayan R. , Karnesis T. , Achen M. G. , Mann G. B. , Stacker S. A. , Taylor G. I. 
Published: April 2007

Purpose  Tumors secreting VEGF‐D or VEGF‐C proteins exhibit increased lymphatic vessel density and lymph node spread (1), however tumor depth and anatomical location also influence metastasis in some tumors. It is unclear whether tumor lymphatics mirror one of the normal lymphatic subtypes or if they form an independent phenotype, and how this may vary in different anatomical locations. We aimed to study lymphatics induced in a VEGF‐D+ tumor model (1), xenografted in different locations, to better understand the vessels that facilitate tumor spread.Methods  We analysed lymphatics formed in mouse skin wounds and tissue from VEGF‐D+ or VEGF‐D‐ tumors in the ear or flank, using immunohistochemical lymphatic marker LYVE‐1 and confocal imaging of fluorescent‐labelled antibodies.Results  VEGF‐D+ tumors that were adherent to skin induced abnormal lymphatic structures that promoted lymph node metastasis (89%) and exhibited morphologically abnormal lymphatics; whereas size‐matched tumors that were adherent to the underlying body wall (similar VEGF‐D levels) metastasised minimally (19%, p < 0.001) and contained no morphologically abnormal lymphatics. Analysis of ear wounds and tumors suggested that lymphatics sprout mainly from the ‘pre‐collector’ lymphatic subtype within skin.Conclusion  Lymphangiogenic growth factors are important but tumor location also plays a role in metastasis. A distinct tumor lymphatic subtype may alsooffer new diagnostic or therapeutic molecular targets.
TN01 HILAR CHOLANGIOCARCINOMA: RADIOLOGICAL DIAGNOSIS, STAGING AND PRE‐OPERATIVE INTERVENTION
Authors: Holden A. H. 
Published: April 2007

Hilar intrahepatic cholangiocarcinoma (I‐CAC) accounts for 25% of CAC. Complete surgical resection offers the best possibility of cure but this demands accurate pre‐operative assessment and staging as well as appropriate ancilllary procedures such as selective portal vein embolisation and targeted biliary drainage.CT (MD‐CT) and MRI are the primary imaging modalities used for the assessment of hilar I‐CAC but despite advances in imaging technology, overall accuracy for assessing resectability of hilar I‐CAC is approximately 60–75% for modalities. Hilar I‐CAC may present as thickening of the biliary wall with infltrative margins or (less commonly) a polypoid intra‐ductal or exophyic mass. The mass typically demonstrates delayed enhancement after contrast as a result of the sclerosis and fibrosis of surrounding tissues frequently seen in CAC. The extent of intraductal tumour spread is more accurately demonstrated with MRI/MRCP but the high spatial resolution of MD‐CT allows possibly more accurate definition of vascular invasion and small lymph metastases. These structures may also be evaluated with pre‐operative laparoscopy. CAC is FDG avid and CT‐PET has a role in detecting nodal and peritoneal metastases.Selective pre‐operative percutaneous transhepatic biliary drainage (PTBD) of the obstructed hepatic segments in the future hepatic remnant has been shown to improve post‐operative outcomes. Pre‐operative selective portal vein embolisation has been used to promote hypertrophy in patients with marginal remnant volumes. The degree of compensatory hypertrophy is an important predictor of outcome and is dependant on technical procedural success and underlying liver disease.
TN11 RENAL ALLOGRAFT COMPRESSION SYNDROME: A REAL ENTITY
Authors: Heer M. K. , Trevillian P. R. , Stein A. , Grant A. , Sprott P. , Hibberd A. D. 
Published: April 2007

Renal allograft compression syndrome (RACS) is being increasingly recognised as cause of early allograft dysfunction.Aim  To assess the validity of RACS.Methods  Clinical and laboratory findings used to diagnose RACS included acute allograft dysfunction (+ oliguria), duplex ultrasound demonstrating diminished, or reversed diastolic flow within interlobar and segmental arteries and, biopsy showing absence of acute rejection or toxicity. Final diagnosis was made at urgent laparotomy. Observations of poor allograft colour and perfusion after reopening the retroperitoneum were considered confirmatory for RACS.Results  Series includes 2 males and 1 female patients. Time elapsed between transplantation and RACS diagnosis was 24–48 hrs. After surgical decompression the allograft perfusion improved visibly in two patients and these cases were then closed with PTFE mesh hood closure. There was no significant improvement observed in the third case that had a renal vein thrombus, which ultimately led to the demise of the graft. Beneficial clinical results were obtained in two cases documented by a sustained decrease in creatinine. Average follow‐up was 9.5 months without any allograft dysfunction.Conclusions  RACS is a real entity with a potential to cause graft loss. Kidney can be salvaged by urgent surgical decompression and PTFE mesh closure.
TN03 BILIARY STENTING IS ASSOCIATED WITH A REDUCED RISK OF BILIARY ANASTOMOTIC STRICTURE FOLLOWING LIVER TRANSPLANTATION
Authors: Fink M. A. , Wang B. Z. , Muralidharan V. , Christophi C. , Jones R. M. 
Published: April 2007

Aim  Biliary complications are a common cause of morbidity following liver transplantation (LT). The risk factors for biliary anastomotic stricture (BAS) are poorly understood. We analysed the risk factors for BAS.Methods  A respective review of a prospective database of patients who underwent LT between 1988 and 2006 in the Liver Transplant Unit Victoria was undertaken. Forty‐five of 502 (9%) LT carried out during this period were complicated by BAS. These cases were compared with 45 controls who underwent LT immediately preceding the cases. Donor, donor operation, recipient, recipient operation and donor/recipient compatibility factors were assessed. Non‐parametric data analysis was used.Results  Cases were less likely to have had a biliary stent placed at LT than controls (74% vs 91%, respectively, P = 0.037). The BAS rate in patients who had a stent at LT was 7.3% compared with 25.5% for those who did not (P < 0.001). There was no difference in BAS rate with differences in stent type (infant feeding catheter vs T tube) or size. Although there were statistically significant differences between cases and controls for donor potassium (3.9+/−0.8 vs 4.0+/−0.4 mmol/L, respectively, P = 0.032) and HCO3 (25+/−3 vs 23+/−3 mmol/L, respectively, P = 0.021), the clinical significance of these differences is questionable.Conclusions  The rate of BAS following LT is higher in patients who did not have a biliary stent placed at the time of LT, though a causative link has not been established.
TN06 BONE BANKING
Authors: Boyle R. A. , Stalley P. D. , Loxton D. , Windolf M. 
Published: April 2007

This paper presents an audit of 22 years of bone banking at Royal Prince Alfred Hospital, along with a review of the current literature regarding the use of allograft bone.Comparisons both locally and internationally are made, and we are confident that standards in Australia are equivalent to those internationally. The requirement for bone graft material in Australia is likely to rise, as more reconstructive and revision surgery is undertaken, along with increases in primary arthroplasty procedures.
TS12 COMBATING COAGULOPATHY
Authors: Gunn K. N. 
Published: April 2007

The clinical trigger to consider the presence of a coagulopathy is the onset of non‐surgically controllable bleeding. While earlier consensus documents considered this event predictable by modelling blood loss, and factor level decline, we now recognize confounding variables such as shock, hypothermia, metabolic disturbances and fibrinolysis confuse the picture to such an extent traditional treatment algorithms are irrelevant. The monitoring of coagulopathy by traditional coagulation screens also lacks validation, and is usually so delayed in response time to become irrelevant to appropriate management.Attaining euvolaemia is possible with large volume dedicated infusion systems but in a patient with massive mediator release and comorbidities may not achieve adequate tissue oxygen delivery. Evidence based transfusion triggers are still lacking. Management of coagulopathy is by component replacement early. Delays occur because of slow coagulation test turnaround times, and the place of newer point of care monitors and thrombelastography needs evaluation. Delay in delivery of blood components due to processing time may worsen the outcome. Factor VIIa probably has a unique place in the management of coagulopathy in these patients, but studies are needed to define dosage and time of dose (2). The management of acidosis and hyperlactaemia are fundamentally improved by better perfusion, but short term correction may be indicated to reinforce coagulation factor function.
TS13 HAEMOSTASIS IN THE AUSTRALIAN DEFENCE FORCE: THE TOURNIQUET CONTROVERSY
Authors: Neuhaus S. J. 
Published: April 2007

In civilian trauma concerns about tourniquet‐related problems has rendered tourniquets virtually obselete. The use of tourniquets in a battlefield setting however remains surrounded by controversy. Whilst many accept that if properly used, tourniquets can be life saving devices, opinion is divided regarding its role. Some surgeons have recommended abolition of the tourniquet, whist others advocate that every combat solder should be issued with a tourniquet as part of their personal equipment. The recent introduction of the self applied C‐A‐T tourniquet into the Australian Defence Force has re‐ignited controversy as to the appropriate role of tourniquets in an operational setting.During Vietnam, Desert Storm and Somalia haemorrhage from extremity wounds was a leading cause of preventable combat deaths. Improvements in body armour and increased exposure to blast injury has resulted in a relative increase in limb injuries in recent operations. Experience in Somalia, Iraq and Afghanistan particularly by Special Operations communities has led to a re‐assessment of the efficacy of battlefield tourniquet systems. The C‐A‐T tourniquet has been widely used in Iraq and Afghanistan. No iatrogenic injury has been reported, even with tourniquet times up to 8 hours.This paper will discuss the history of tourniquet use in the military from its first introduction in 1674 to the most recent ADF doctrine (ADFP XXX). It will also present trial results from the UK and US and recommendations from the 2006 Advanced Technologies Applied to Combat Casualty Care Conference (ATACC).This paper will address the basis of current doctrine and provide a case for and against the use of tourniquets in an operational setting.
TS15P UNCOMMON ABDOMINAL HEMORRHAGE DUE TO BLUNT TRAUMA: BLENDING FROM AN ASYMPTOMATIC ABDOMINAL TUMOR INJURY – A CASE REPORT
Authors: Collet e Silva F. S. , Bardella R. , Fontes B. , Poggetti R. S. , Birolini D. 
Published: April 2007

Asymptomatic tumors are not uncommon, may be diagnosed during clinical examination or during surgical interventions for other purposes such as treatment of a hemorrhage due a blunt trauma.Case report  6 year‐old boy had fallen, hitting his abdomen against a rock, and arrived at hospital ten hours later. Initial assessment he was complaining of diffuse abdominal pain; his physical examination showed: respiratory rate: 16 mov/min, blood pressure: 100 × 80 mmHg, heart rate: 100 bat/min, and Glasgow coma score: 15. His abdomen was distended, with guarding and rebound tenderness, and had a palpable mass. FAST ultrasound was positive; and Ct‐scan showed an abdominal mass with 15 × 12 × 7 cm dimension, and moderate amount of free blood in the abdominal cavity. Laboratory tests showed: hemoglobin 9.9 mg/dl, hematocritic 28.8%, white blood cells 6.900 cel/dl.Midline laparotomy was performed, a large, injured and bleeding mesenteric mass was found encircling superior mesentery artery and several small bowel loops; 500 ml of free blood was found in the peritoneal cavity. Mesenteric mass was partially removed with a segment of the small bowel. Findings of anatomico‐pathologic examination revealed an intestinal Burkitt lymphoma, with mesenteric linfonodes. Patient had an uneventful postoperative course, and started with quimotherapy.Comments  This case report shows an unusual traumatic abdominal blending that could not be clearly diagnosed before laparotomy was performed. The emergency of this case was bleeding control, decision to remove mass was taken only for this purpose, and not to treat the tumor. As removal of the whole mass was impossible, a partial removal was performed.