bluuebunny/crossref_metadata_2025_split huggingface dataset:
CT17P IMAGES OF AN INFARCT RELATED INCOMPLETE LEFT VENTRICULAR RUPTURE MANAGED WITH PERICARDIAL PATCH REPAIR
Authors: Galvin S. D. , Bunton R. W. , Chen V. 
Published: April 2007

Introduction  A 54‐year‐old woman presented with an inferior MI & post infarction pericarditis. Incomplete LV rupture was confirmed by MRI. She was managed with pericardial patch repair of her LV.Case  Our patient presented with 1 week of chest pain, elevated Troponin T & ECG suggesting a recent inferior MI. Angiography showed an occluded obtuse marginal artery, left ventriculogram a 1 cm endocardial defect in a hypokinetic segment of the infero‐lateral LV & transthoracic echo a small LV wall defect with a haemodynamically insignificant pericardial effusion. Cardiac MRI confirmed an infero‐lateral infarct & an anatomical defect suggesting incomplete rupture of the LV free wall. Operatively straw colored pericardial fluid & a shaggy pericarditis were noted. Myocardium supplied by the obtuse marginal artery had appearances of recent infarction & on cardiopulmonary bypass a pericardial patch was glued over this area. The patient required elective drainage of a persistent pericardial effusion and was discharged on the 13th post‐operative day. 4 weeks after discharge she was asymptomatic with echo showing a resolving pericardial effusion.Discussion  Incomplete LV rupture following MI is rare & caused by haemorrhagic dissection of the ventricular wall leaving a defect lined by epicardium alone. The natural history is not well described but may include free wall rupture with an in‐hospital mortality of 70%. Pericardial patch augmentation of the LV may reduce the risk of free wall rupture.Conclusion  Management of incomplete LV rupture is poorly described but reinforcement of the area with a pericardial patch may be performed safely to reduce the risk of free wall rupture.
CT19P TRICUSPID VALVE REPAIR IN ‘TORRENTIAL TRICUSPID REGURGITATION’ FOLLOWING PERMANENT PACEMAKER LEAD EXTRACTION – A CASE REPORT
Authors: Mehrotra D. , Miller A. , McAlister H. , Kejriwal N. K. 
Published: April 2007

Introduction  Traumatic tricuspid regurgitation secondary to blunt chest trauma has been reported in literature. We report our experience with a case of ‘Torrential Tricuspid Regurgitation’ following permanent pacemaker lead extraction which was successfully treated with tricuspid valve repair and annuloplasty.Report  A 67 year old woman was treated for Sick sinus syndrome with permanent pacemaker implant. She had three generator changes for end of life and repositioning.Erosion of generator, led cardiologist to plan lead and generator extraction with the surgical backup. During lead extraction a small piece of papillary muscle was avulsed. The patient remained hemodynamically stable in the theatre. However in ward she developed right sided cardiac failure not responding to conservative therapy. A transthoracic echo (TTE) revealed torrential tricuspid regurgitation with a freely mobile posterior leaflet with attached chordae and avulsed papillary muscle.During surgery the tricuspid valve was successfully repaired and transesophageal (TOE) images showed trivial to mild tricuspid regurgitation at the end of repair procedure. Additional procedure also included ligation of both atrial appendages and implantation of epicardial leads and pacemaker. Patient made good recovery from operation.Conclusion  To the best of our knowledge this is first report of repair of tricuspid valve in ‘Torrential Tricuspid Regurgitation’ following pacemaker lead extraction. We share our experience with tricuspid valve repair technique and annuloplasty.
CT24 ICU PROTOCOLS
Authors: Bowie D. R. 
Published: April 2007

During its development in the past 4 decades the perioperative care of cardiac surgery patients has been the most protocolised in any branch of surgery. Initially this protocolisation was developed to allow the introduction to the clinical environment of applied physiology which had previously only been possible in the research laboratory. Invasive pressure monitoring, blood chemistry management, cardiac performance manipulation and coagulation control were all subject to rule based management which could be successfully implemented by staff with a wide range of knowledge and experience.Coronary Artery Surgery is now proported to be the commonest single procedure performed in North America and what was once considered ‘Miraculous’ is now routine. Active Physiological management which was once only the realm of specialised units is now taught to all medical students. The protocols used in the perioperative management of 21st century cardiac surgery patients although still based on sound physiological criteria are now directed towards resource optimisation. Low mortality is now a given and so techniques which decreasing ICU and hospital stay and maximise value for money while at the same time decreasing complication rates are the new focus.
CT03 RESULTS OF LEFT CORONARY OSTIOPLASTY FOR PROXIMAL SHORT SEGMENT LEFT MAIN STENOSIS
Authors: Peeceeyen C. S. , Paterson H. 
Published: April 2007

Background  Surgical angioplasty of left main coronary artery (LMCA) in critical left main stenosis has been described as an alternative to CABG to restore antegrade coronary perfusion. We review our experience with onlay saphenous vein patch augmentation for ostial and short segment proximal left main stenosis in selected patients.Methods  All data were compiled prospectively and medical records reviewed. Follow up information obtained form cardiologists and local doctors through telephonic questionnaires.Results  Between May 1997 and August 2005, 14 left coronary ostioplasties (9 posterior and 5 anterior approaches) were performed in 13 patients. One patient had to be taken off the study group because of failed posterior ostioplasty that was identified on table. Another patient who had previous CABG and persistent angina despite patent grafts, had symptomatic relief following left main ostioplasty.No peri‐operative mortality or myocardial infarction. All patients were followed up for an average period of 5 years. One patient had kinked anterior onlay patch and underwent ostioplasty by posterior approach subsequently. One patient died two years postoperatively due to stroke. All others were leading active symptom free lives. 4 (3 posterior and 1 anterior) follow up coronary angiograms showed widely patent LMCAs.Conclusion  Left coronary ostioplasty is a safe procedure, which promises excellent results.Eventhough it is considered as an alternative to CABG, in certain situations may be needed as an adjunct to patent grafts to achieve total revascularization. The anterior approach may be technically easier, but there is a definite risk of kinking of onlay patch.
CT04 ULTRA MINIMALLY INVASIVE MITRAL VALVE SURGERY WITHOUT AORTIC CROSS CLAMP
Authors: Kumar S. , Ahmad R. , Greelish J. , Petracek M. , Balaguer J. , Byrne J. 
Published: April 2007

Objective  We developed a technique for mitral valve surgery through an ultra small (5 cm) right lateral thoracotomy without aortic cross clamp. This study reports our combined ST. Thomas and Vanderbilt Heart Institutes five years experience with this technique.Methods  Six hundred and twenty five (316 M /309 F; aged 22–75 mean of 62 years) underwent ultra minimally invasive mitral valve surgery between August 2000 and June 2006. Through a 5 centimeter right lateral thoracotomy along the 4th intercostal space access to the pericardium and the left atrium was gained. Cardiopulmonary bypass was instituted through femoral cannulation. Under cold fibrillatory arrest (28°C) without aortic cross clamp, mitral valve repair (n = 196) or replacement (n = 380), in addition to mitral valve procedure we performed tricuspid valve repair (n = 69), ASD/PFO closure (n = 201) and Maze (n = 156). Mean pre operative New York Heart Association function class was 2.2 ± 0.9. Twenty eight patients had ejection fraction less than 20%.Results  Thirty‐day mortality was 1.28% (n = 8), Operating time, bypass time operating averaged 189 ± 52, 113 ± 35 minutes, respectively. Three patients had conversion to sternotomy. Fifteen patients (2.4%) underwent reexploration for bleeding. Average length of hospital stay from surgery to discharge was 6.85 ± 3 days. Ten patients (1.6%) had neurological events. Renal failure required hemodialysis in 5 patients (0.81%). Long term follow‐up results are awaited.Conclusions  This study demonstrate that this simplified technique of ultra minimally invasive mitral valve surgery is reproducible and provides the least invasive operative approach with low mortality and morbidity with good cosmetic results.
CT05 MECHANICAL VALVE OR TISSUE VALVE: DO PATIENTS REGRET THEIR DECISION?
Authors: Macemon J. B. , Smith S. T. , Shaw D. P. 
Published: April 2007

Purpose  Patients undergoing heart valve replacement are usually given a choice of valve type, mechanical or tissue. Each of these broad valve types has basic advantages and disadvantages which are discussed with the patient pre‐operatively, allowing them to make their decision. Post‐operatively patients have a variety of experiences, related to the valve itself, complications of the operation, and other co‐morbidities. The aim of this study was to determine patient satisfaction with the type of valve they chose, and whether they would have changed their mind given their experience.Methodology  A one page postal survey with multiple choice questions was sent to 350 patients identified on the hospital database who had undergone cardiac valve replacement. The data obtained was compared to database information and analysed.Results  Patients reported a variety of experiences following their discharge from hospital, from thrombo‐embolic events, arrhythmias, bruising and bleeding and ongoing warfarin dosing difficulties. Very few patients (<0.5%) stated that given their experience would have chosen a different type of valve. Also few patients (<5%) who received biological valve replacements ended up requiring warfarin long term.Conclusions  Despite many patients having significant problems post‐operatively, very few regret their choice of valve type.
CR01 SHORT GUT SYNDROME
Authors: Heriot A. G. 
Published: April 2007

Introduction  Short gut syndrome is a rare but devastating condition that can be associated with significant morbidity and mortality.Methods  A literature search was performed using Medline, Embase, Ovid, and Cochrane database for studies between 1980 and 2005 using key words including intestinal failure and short gut syndrome. This was combined with clinical experience of patient management at tertiary colorectal surgical institutions in Australia (St Vincent’s, Melbourne), United Kingdom (St Mark’s, London), and the USA (Cleveland Clinic, Cleveland, Ohio).Results  Short gut syndrome may occur secondary to reduction in actual or functional small bowel length, decreased absorptive capacity or functional ability. Three stages of intestinal failure can be recognised, hypersecretory (1–2 mths.), adaptive (3–12 mths.), and stabilisation (12–24 mths.) phases. There are significant pathophysiological changes to small bowel function during these stages affecting management of both fluid and electrolytes and nutrients, which must be proactively managed. Short gut syndrome often develops in the setting of a surgical catastrophe. Management can be summarised in terms of the 4 ‘R’s’, resuscitation, restitution, reconstruction, and rehabilitation. Patients should be managed in the context of a multidisciplinary team including gastroenterological, surgical, and nursing input. Home parenteral nutrition is essential for a proportion of the patients and small bowel transplantation may be a therapeutic option.Discussion  Short gut syndrome is a complex management conundrum that has acute and chronic impact. A multidisciplinary team management, initially in a tertiary hospital environment, is essential.
CR14 EFFICACY OF PERITONECTOMY FOR PERITONEAL CARCINOMATOSIS FROM COLORECTAL CANCER
Authors: Yan T. D. , Morris D.L. 
Published: April 2007

Purpose  The objectives of this report were to critically evaluate the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy (peritonectomy) for patients with peritoneal carcinomatosis from colorectal carcinoma.Methodology  Forty patients with histologically confirmed peritoneal dissemination from colorectal cancer underwent peritonectomy at the St George Hospital, Sydney. All clinical and treatment‐related data were prospectively collected. Perioperative and survival results were analysed by intention‐to‐treat principle.Results  The mean age at the time of surgery was 54 (S.D. = 14) years. There were 25 male patients. Three, 20 and 17 patients had well‐, moderately‐ and poorly‐differentiated tumours. The mean peritoneal cancer index was 12 (S.D. = 9). The mean operation duration was 7 (S.D. = 4) hours. The mean ICU, HDU and overall hospital stay was 1 (S.D. = 0.5), 5 (S.D. = 8) and 28 (S.D. = 34) days, respectively. Seventeen patients (42%) had moderate morbidity and required interventional procedures for resolution. Six patients (15%) had severe morbidity and required returning to ICU or operating theatre for management. There was no operative death. After a median follow‐up of 12 months since peritonectomy, the overall median survival was 30 months (range 1 to 46), with 1‐ and 2‐year survival of 67% and 61%, respectively.Conclusions  Peritonectomy is a treatment option for selected patients with peritoneal carcinomatosis from colorectal carcinoma.
CR03 SMOKING IS A MAJOR RISK FACTOR FOR ANASTOMOTIC LEAK AFTER LOW ANTERIOR RESECTION
Authors: Richards C. H. , Hayes J. , Thomson‐Fawcett M. , Elliot T. 
Published: April 2007

Purpose  To identify risk factors for anastomotic leak after colonic and rectal anastomosis at our institution.Methodology  Data was collected prospectively by Otago Clinical Audit between 1/1/2000 and 31/12/2004. All operations involving a colonic or rectal anastomosis were included. For all patients the association between clinical anastomotic leakage and seven demographic and clinical variables was assessed. For the subgroup of 118 patients who underwent low anterior resection, data on a further fifteen variables related to operative technique, lifestyle factors and pathology were obtained from chart review. The association between these and leakage was assessed. Continuous variables were analysed with t‐tests. Categorical variables were analysed with univariate logistic regression, and Odds ratios (OR) with 95% confidence intervals (CI) were calculated.Results  Over the five‐year period, 878 patients had an operation with a large bowel anastomosis. The overall rate of anastomotic leakage was 4.8% (42 of 878). In this group, longer operating time (p < 0.01) and a low rectal anastomosis (OR 3.12; CI 1.44, 6.41) were significantly associated with anastomotic leak. The leak rate for low anterior resections was 12.7% (15 of 118). Involved lymph nodes (OR 6.7; CI 1.31, 64.7), metastatic disease (OR 4.32; CI 1.12, 16.7) and cigarette smoking (OR 17.6; CI 4.84, 63.8) were significantly associated with anastomotic leak in this subgroup.Conclusions  Current smokers and patients with advanced malignancy undergoing low anterior resection are at highest risk of anastomotic leak. These findings need to be confirmed prospectively and may have implications for clinical decision making.
CR05 BACTERIA NOT COMMONLY ASSOCIATED WITH HUMAN FAECES IMPLICATED IN ETIOLOGY OF POUCHITIS
Authors: Thompson‐Fawcett M. W. , Tannock G. W. , Lay C. , Baladjay L. , Daynes C. , McLeod R. S. 
Published: April 2007

Purpose  Chronic pouchitis is an important long‐term complication following ileal pouch formation. Antibiotics reduce symptoms indicating bacteria play a role in pathogenesis. We analyzed and compared the bacterial content (microbiota) of stool collected from chronic pouchitis and familial adenomatous polyposis patients. Additionally, we compared the microbiota of chronic pouchitis patients on and off antibiotics. We aimed to determine which of the bacterial inhabitants of pouches had a role in the pathogenesis of pouchitis.Methods  The stool microbiota of 17 patients with chronic pouchitis and of 15 familial adenomatous polyposis patients were analyzed by nucleic acid‐based methods (temporal temperature gradient gel electrophoretic profiles, fluorescence in situ hybridization with flow cytometry).Results  The composition of the stool of chronic pouchitis and familial adenomatous polyposis patients was markedly different. Electrophoretic profiles of the stool microbiota of familial adenomatous patients clustered at the 80% level of similarity, whereas those of chronic pouchitis patients were disparate. The results of fluorescence in situ hybridization analysis showed that bacteria not commonly present in human faeces, nor in the stool of familial adenomatous polyposis patients, comprised about 50% of the stool microbiota of untreated chronic pouchitis patients. Antibiotic treatment reduced the proportion of these unknown bacteria in the stool of every chronic pouchitis patient.Conclusion  Chronic pouchitis is associated with a microbiota that contains bacteria not commonly associated with human faeces. These bacteria are reduced with antibiotics and are likely to be the pathogenic agents of chronic pouchitis.
CR09 MANAGING FAECAL INCONTINENCE: THE ROLE OF PTQ INJECTIONS
Authors: Gett R. M. , Gyorki D. , Keck J. , Chen F. , Johnston M. 
Published: April 2007

Purpose  An attenuated or disrupted anal sphincter can lead to faecal incontinence. One means of augmenting the sphincter is with the use of the silicone‐based biomaterial PTQ. The aim of this study was to evaluate the effectiveness of PTQ for the symptoms of passive faecal incontinence caused by a weak sphincter mechanism.Methods  The patient records of 37 patients with passive faecal incontinence treated by 2 surgeons were examined. Their faecal incontinence scores were recorded from pre‐operative consultations and then in a follow‐up phone interview. Any adverse effects of treatment were recorded including significant pain, development of perianal abscesses and loss of injected silicone.Results  Thirty‐seven patients received PTQ injections and completed follow up interviews. The main cause of faecal incontinence for this group was obstetric trauma. The follow‐up period was from 1–43 months with a median of 9 months. Twenty‐five patients experienced improvements in their faecal incontinence with 7 patients remaining unchanged and 5 worse symptomatically. The median improvement in faecal incontinence scores was 3 with an average of 3.76. It was important to note that the improvement was more marked in follow‐up over 18 months, with an average of 4.5. Four patients developed post injection abscesses, the most common adverse outcome and these were successfully treated with surgical drainage.Conclusion  PTQ injections are a successful and minimally invasive treatment in the management of passive faecal incontinence. Two thirds of patients were improved with the injection of PTQ. Ten percent of the patients developed injection related abscesses.
ES10 SURGICAL MANAGEMENT OF WELL‐DIFFERENTIATED THYROID CANCERS; RISK GROUP STRATIFICATION AND PREDICTORS OF OUTCOME
Authors: Sarinah B. , Hisham A. N. 
Published: April 2007

Objective  The aim of this study was to evaluate the predictive ability of outcomes in the management of well‐differentiated thyroid cancers (WDTC).Method & Materials  A total of 115 patients operated for primary WDTC from 2002 to 2006 were included in this study. The patient’s demographic data, clinical manifestation, tumour characteristics and outcomes were reviewed. Risk group stratifications were applied using pTNM, AMES and MACIS prognostic systems.Results  There were 81(70%) women and 34(30%) men with the median age of 44 years (ranged 6 to 78 years). Our results showed that at the median follow up period of 19 months, 93(80.1%) patients are still alive without recurrence disease, 5(4.3%) patients succumbed to the disease and 3(2.6%) are still alive with persisting disease. Local and nodal recurrence occurred in 14(12.2%) patients after primary surgery, of which 12(10.4%) patients already had nodal metastasis at presentation. All 5 patients who succumbed to the disease were proven to be advanced stage with nodal metastasis, coupled with incomplete surgical resection. In addition 3(2.6%) of them also had distant metastasis at presentation. All patients who died were in the high‐risk groups of AMES scoring system, either staged 3 or 4 of pTNM classification and/or scored more than 8 in MACIS prognostic scoring.Conclusions  Our study emphasized the important of risk group stratification, which may indicate the need for a more aggressive surgical treatment. Poorer survival and outcome is expected if WDTC are locally advanced with nodal and distant metastasis coupled with inability to achieve complete resection.
ES17P IPTH FACILITATES DAY 1 DISCHARGE AFTER TOTAL THYROIDECTOMY: THE FIRST 50 CASES
Authors: Grodski S. , Lundgren C. , Sywak M. , Sidhu S. , Delbridge L. 
Published: April 2007

In recent years there has been much published about the use of iPTH to predict hypocalcemia with a view to achieving earlier safe discharge after total thyroidectomy. After recent publication of Australian data on this practice we developed a new protocol for post‐operative calcium management with the aim of achieving a greater number of patients being safely discharged on the first post‐operative day. We present our experience with the first 50 patients being treated under the new protocol.The first 50 patients admitted for total or completion thyroidectomy since May 2006 were studied and compared to 50 consecutive patients from 2002–2003, before the iPTH assay was used for thyroid surgery. iPTH was measured at 4‐hours post‐operatively and patients with iPTH in the normal range were discharged on the first post‐operative day. Statistical analysis was performed using the Mann‐Whitney U test.Fifty patients in each group were analyzed. Mean age in the study group was 56 years (51 years in the control group) and sex distribution were similar in both groups (M : F, 1 : 3). Mean lowest post‐operative corrected calcium levels in the study group were 2.19 mmol/L (2.15 mmol/L in the control group). Length of stay was significantly shorter in the study group, mean 1.71 days vs. 2.20 days (P < 0.05).The use of iPTH accurately predicts hypocalcemia after total thyroidectomy and can be used to facilitate safe early discharge for patients. This study demonstrates a significant reduction in the length of stay for patients undergoing total thyroidectomy when managed with a protocol based on a 4‐hour iPTH level.