bluuebunny/crossref_metadata_2025_split huggingface dataset:
LASER PHOTOCOAGULATION IN THE TREATMENT OF MALIGNANT DYSPHAGIA
Authors: Hurley James F. G. , Cade Richard J. 
Published: January 2008

Background: Dysphagia secondary to carcinoma of the oesophagus and gastric cardia is the principal symptom requiring palliation in those patients who present with late‐stage disease or who are unfit for surgery. The primary aim of the present study was to determine the safety and efficacy of laser photocoagulation in the palliation of malignant dysphagia. Secondary aims were to look at reasons for failure and predictors of outcome; to determine the most appropriate second line therapy for treatment failures; and to look at the results of treatment for early stage disease. Methods: Sixty‐seven patients treated over a 6‐year period with endoscopic Nd:YAG laser photocoagulation were evaluated and the quality of swallowing assessed before and at intervals after treatment. Results: Ninety per cent of patients achieved successful initial palliation. This was sustained in 76% after 3 months of treatment. Within a month before death 71 % of patients were palliated but 29% required the addition of second‐line treatment to achieve this. Complications were infrequent. There were no deaths attributable to laser treatment. Five of 10 patients treated with radiotherapy developed fibrous stricturing that required endoscopic dilatation. No variables were independently predictive for treatment failure. Six patients with early stage disease experienced prolonged survival. Conclusions: We conclude that laser photocoagulation offers safe and effective palliation of malignant dysphagia in this group of patients and is appropriate as first‐line therapy.
ANALYSIS OF 274 OMNIFLOW VASCULAR PROSTHESES IMPLANTED OVER AN EIGHT‐YEAR PERIOD
Authors: Koch G. , Gutschi S. , Pascher O. , Fruhwirth H. , Glanzer H. 
Published: January 2008

Background: Polytetrafluoroethylene (PTFE), dacron, and, more recently, collagen prostheses are finding increasing use for femoropopliteal reconstruction when a suitable vein is not available. The main factors to be considered when choosing a prosthesis are patency, susceptibility to infection and formation of aneurysms. Methods: Sheep collagen prostheses were implanted on 274 occasions in the femoropopliteal or crural regions. Results: The patency rate for supragenual bypass after 3 years was 61.9% with good vascular periphery and 44% with poor vascular periphery. If the prosthesis extended below the knee, the patency rate was 55.4% with good and 35.3% with unfavourable vascular periphery. Patency for the femorocrural bypass was 28.7% after 2 years. The rate of infection was 0% and an aneurysm occurred in three patients (1.1%). Conclusions: With this low infection rate and the very slight danger of aneurysm, the long‐term results suggest that the ovine collagen prosthesis can be recommended for use when no suitable vein is available.
HYDRODISSECTION: AN EASY WAY TO DISSECT ANATOMICAL PLANES AND COMPLEX ADHESIONS
Authors: Bokey E. L. , Keating J. P. , Zelas P. 
Published: January 2008

Background: Sharp dissection of adherent tissues resulting from previous sepsis or surgery is frequently time‐consuming and sometimes difficult. Methods: The introduction of saline under pressure into the plane of dissection facilitates this task. Results: Hydrodissection both creates and displays the correct plane between adherent tissues. Conclusions: This technique increases the safety and decreases the time spent in adhesiolysis in re‐operative surgery.
THE POINT PREVALENCE OF WOUNDS IN A TEACHING HOSPITAL
Authors: Gruen Russell L. , Chang Stanley , MacLellan Donald G. 
Published: January 2008

Background: Wounds are a common problem, particularly in the elderly population. The scale of wound problems in hospital is largely unknown because wounds are widely dispersed. The present study examined the point prevalence of hospital wounds and undertook a pressure ulcer risk assessment of all patients on one day. Methods: All 360 inpatients were surveyed and thoroughly examined. A risk scale for pressure sore development, the Norton score, was applied. When wounds were found, information was collected to determine their aetiology. Results: Forty leg ulcers, 40 pressure sores, 85 surgical wounds and seven other types of wounds were found. Most leg ulcer and pressure sore cases were admitted for other reasons. The Norton score did not predict all cases of pressure ulceration. A total of 52% of wounds did not qualify for additional funding under current funding criteria. Conclusion: The prevalence of non‐surgical wounds in Heidelberg Repatriation Hospital was easily underestimated. Wound care management can be optimized by staff education and protocol design, early identification of troublesome wounds and of at‐risk patients, and a cross‐sectional approach that incorporates wound‐management teams.
THE EFFECT OF LAPAROSCOPIC CHOLECYSTECTOMY ON GASTRODUODENAL REFLUX
Authors: Maddern Guy J. , Baxter Paula S. 
Published: January 2008

Background: The present study evaluates the effect of laparoscopic cholecystectomy on biliary reflux in patients with cholelithiasis. Methods: All patients over 18 years of age awaiting elective cholecystectomy for gallstone disease in one of two teaching hospitals were contacted by telephone, and those who gave informed consent were entered in the study. A total of 66 patients (43 females and 23 males) underwent milk 99mTc DIDA scans. Elective laparoscopic cholecystectomy was perfomed after a median of 28.5 days (range: 8–588 days) and patients were re‐investigated with a milk 99mTc DIDA scan at a median time of 50 days (range: 18–370 days) postoperatively. Scans were carried out in the Nuclear Medicine Department of the Royal Adelaide Hospital. Results: All but two patients had a functioning gall‐bladder on milk 99mTc N‐2, 6‐dimethylphenyl‐carbamoylmethyl iminodiacetic acid scanning prior to cholecystectomy. One of these patients was found to have a gall‐bladder carcinoma at cholecystectomy. Fifty‐seven of the 66 patients had a successful laparoscopic cholecystectomy (nine open cholecystectomies). Nineteen patients experienced gastroduodenal reflux into the stomach prior to cholecystectomy and 23 patients experienced it postoperatively. There was no significant difference in gastroduodenal reflux in both the open and laparoscopic groups. Conclusion: The present study demonstrated that laparoscopic cholecystectomy did not significantly alter gastroduodenal reflux.
TRENDS IN SURVIVAL FROM COLONIC CANCER: THE IMPACT OF SUBSPECIALIZATION
Authors: Hoffmann D. , Moore J. , Roder D. 
Published: January 2008

Background:Data from population‐based registries have demonstrated a recent increase in case survival for colonic cancer which has been attributed to earlier diagnosis. The present study was performed to identify time trends in case survival for patients with colonic cancer in a single institution, and to identify factors associated with any such improvement. Methods: Data regarding 1264 patients with colonic cancer who were diagnosed between January 1981 and December 1995 were obtained from the Royal Adelaide Hospital Cancer Registry. Prognostic factors examined were age, sex, Australian clinicopathologic stage (ACPS), differentiation and year of diagnosis. Survival analyses were performed using the Kaplan‐Meier method, and differences between patient subgroups were tested using univariate and multivariate Cox analyses. Patterns of adjuvant therapy were stable throughout the study period. Results:The study group comprised 1264 patients. Key independent predictors of case survival after controlling for covariables were found to be earlier‐stage disease (P < 0.001), moderately or well differentiated tumours (P < 0.001), and more recently diagnosed tumours (P= 0.011). Specifically, the 5‐year survival rates (± SE) increased from 40.3% (± 3.2) for 1981–83 to 48.3% (± 3.3) for 1984–86 and 51.6% (± 2.1) for 1987–95. This increase in case survival was temporally associated with the establishment of a specialty colorectal surgical unit within the Royal Adelaide Hospital. Conclusions:This study of patients with colonic cancer from a single institution confirms previously observed, population registry‐based, increases in case survival over recent years. Such improvement was independent of trends in tumour stage and differentiation and the use of adjuvant therapies. This provides evidence that survival outcomes for colonic cancer are influenced by surgical expertise.
CADAVERIC LIVER PROCUREMENT USING AORTIC PERFUSION ONLY
Authors: Chui A. K. K. , Thompson J. F. , Lam D. , Koutalistras N. , Wang L. , Verran D. J. , Sheil A. G. R. 
Published: January 2008

Background: To test the effectiveness of a simpler surgical technique for cadaveric liver procurement for liver transplantation, a prospective randomized study was carried out between August 1994 and December 1995, to compare aortic perfusion only (APO) for flush‐preservation of the liver with the conventional combined aortic and portal perfusion (APP) technique. Methods: Forty multiple organ donors were enrolled with 20 in each arm of the trial. Donor parameters (age, bodyweight, liver function tests), surgeons performing the operations, the involvement of other procurement teams and the total ischaemic times were similar in the two groups. The liver recipients had a wide range of native liver pathology but were of similar age, sex and bodyweight in the two groups. Results: The mean procurement operation times for the APO and APP groups were 126.7 ± 38.6 and 137.8 ± 55.9 min, respectively (P= ns). The perfusion took longer to complete in the APO group (10.2 ± 1.7 vs 7.2 ± 1.4 min (APP), P < 0.001). The liver temperature fell to its lowest level (12.5 ± 3.4°C (APO) vs 11 ± 3°C (APP), P= ns) in a similar time (11.9 ±3.8 min (APO) vs 9.3 ± 3.4 mins (APP), P= ns). There was no graft primary non‐function or graft arterial injury in either group. There was no significant difference between the APO and APP initial graft outcomes. The 3‐month patient survival rate was identical in the two groups (95%); 81% of renal grafts from the APO donors functioned well from the time of transplantation as did 76% of those from APP donors. Conclusions: It is concluded that the APO procurement technique produces equivalent results to those achieved with the APP method. The simplicity of the APO technique makes it the preferred technique.
THE ROLE OF THE JOURNAL CLUB IN SURGICAL TRAINING
Authors: Spillane A. J. , Crowe P. J. 
Published: January 2008

Background: The development of skills in critical appraisal of the medical literature is an important aspect of surgical training. Methods: At the Prince of Wales Hospital a journal club has been conducted for more than 5 years to improve the registrars' training in this area. A questionnaire was circulated regarding the success of the journal club at achieving adequate review of the important current literature, development of critical appraisal skills by registrars and providing a convivial social gathering. Results: A total of 28 out of 39 current or previous journal club members responded to the questionnaire. Twenty‐three of the respondents felt that the journal club provided a good to excellent review of current literature, 26 felt that the journal club facilitated development of critical appraisal skills and all 28 said that the journal club was a convivial social forum. Eight research projects developed from journal club reviews, 19 of the respondents reported that their clinical practice had changed, and 19 had been stimulated to further review a topic as a result of the journal club. Many of the respondents had specific criticisms of the journal club, and these have been used to improve the journal club format. Conclusions: The present study has highlighted the strengths and weaknesses of our journal club. The journal club is a valuable component of surgical education.
ISCHAEMIA‐REPERFUSION INJURY TO THE INTESTINE
Authors: Kong Sung‐Eun , Blennerhassett Lewis R. , Heel Kathryn A. , McCauley Rosalie D. , Hall John C. 
Published: January 2008

Ischaemia‐reperfusion injury (IRI) is of obvious relevance in situations where there is an interruption of blood supply to the gut, as in vascular surgery, or in the construction of free intestinal grafts. It is now appreciated that IRI also underlies the gut dysfunction that occurs in early shock, sepsis, and trauma. The events that occur during IRI are complex. However, recent advances in cellular biology have started to unravel these underlying processes. The aim of this review is to provide an outline of current knowledge on the mechanisms and consequences of IRI.Initially, IRI appears to be mediated by reactive oxygen metabolites and, at a later stage, by the priming and activation of polymorphonuclear neutrophils (PMN). Ischaemia‐reperfusion injury can diminish the barrier function of the gut, and can promote an increase in the leakage of molecules (intestinal permeability) or the passage of microbes across the wall of the bowel (bacterial trans‐location). Ischaemia‐reperfusion injury to the gut can result in the generation of molecules that may also harm distant tissues.
ENDOLUMINAL REPAIR: A BETTER OPTION FOR THE TREATMENT OF COMPLEX FALSE ANEURYSMS
Authors: May James , White Geoffrey H. , Yu Weiyun , Waugh Richard , Stephen Michael S. , Harris John P. 
Published: January 2008

Background: The aim of the present paper is to present the utility of endoluminal repair in the management of complex false aneurysms at various sites throughout the body. Methods: Between May 1992 and May 1997 the endoluminal method was used to repair 183 aneurysms at various sites throughout the body. In six patients the pathology was that of false aneurysm and these are the basis of the present report. In two of the patients the false aneurysm was situated between the renal arteries and the proximal end of a previous aortic graft. The other false aneurysms were situated in the right subclavian, the popliteal and internal carotid arteries, in addition to one situated at the junction of two longstanding bypass grafts in the groin. The technique involved delivery of an endograft into the artery from which the false aneurysm had arisen via a sheath inserted through an artery of access which was superficial and remote from the site of the aneurysm. A laparotomy was avoided in the first two cases and thoracotomy avoided in the third case. Opening of the popliteal fossa, which had been the site of a recent knee replacement in the fourth patient, was also avoided. Results: Post‐procedure angiography confirmed exclusion of the false aneurysm from the general circulation in all six patients. There were no deaths and the mean length of hospital stay was 6 days. Conclusions: Endoluminal repair of false aneurysms is feasible and avoids the difficulty and morbidity associated with laparotomy, thoracotomy and operations at sites with scarring from previous interventions.
FREE VERSUS PEDICLED OMENTAL GRAFTS FOR LIMB SALVAGE IN BUERGER'S DISEASE
Authors: Talwar S. , Jain S. , Porwal R. , Laddha B. L. , Prasad P. 
Published: January 2008

Background: Buerger's disease is a disabling and progressive disease that affects young smokers with a variable and unpredictable course. Free or pedicled omental transfer are the possible modes of management for these patients, and these modes are compared in the present study. Methods: Of the 43 patients who had Buerger's disease who were treated at the Department of Surgery, Jawahar Lai Nehru (JLN) Hospital, Ajmer, between January 1990 and December 1995, 15 patients underwent application of free omental grafts (group A); 28 patients underwent pedicled omental transplantation (group B). The clinical results obtained with the use of either technique were compared. Results: There were no statistically significant differences in the relief of intermittent claudication (80% v.v 82%), rest pain (82%vs 91%), coldness (83%vs 87%), discolouration (80%vs 82%), ulceration (75%vs 78%) and post‐amputation ulcer healing (75%vs 86%) in the two groups (P > 0.05); but the time taken for the relief of intermittent claudication, rest pain and coldness was significantly less in group B. Major amputations were not required in both the groups. Conclusions: These findings suggest that the ultimate clinical benefits obtained with the use of either free or pedicled omental grafts in patients with Buerger's disease are similar, supporting a possible local action of the omentum.
CHARACTERISTICS AND TREATMENT OF BREAST CANCERS 10 MM OR LESS DETECTED BY A MAMMOGRAPHIC SCREENING PROGRAMME
Authors: Kitchen P. R. B. , Cawson J. N. , Winch K. L. , Henderson M. A. 
Published: January 2008

Background: Small invasive breast cancers up to 10 mm in size have an excellent prognosis and are being detected in increasing numbers by mammographic screening, yet optimal treatment remains controversial. Methods: A review was made of pathology and treatment data relating to 100 consecutive invasive breast cancers up to 10 mm in size detected among 52 126 women who were screened over a 32‐month period. Results: The most common radiological finding was a stellate lesion (44%). Thirty‐three cases had an extensive in situ component in addition to the invasive tumour, and included among these were seven ductal carcinoma in situ (DCIS) cases with microinvasion. Of 79 patients who had axillary dissections, seven (9%) were node‐positive. Tumours ≤ 5 mm were as likely to be node‐positive (11%) as those 6–10 mm in size (8%). Positive nodes were found only in patients with more than five nodes excised. Breast conservation surgery was performed in 84% of patients treated by surgeons associated with the programme, and 63% of patients were treated by other surgeons (P= 0.054, exact test). Breast radiation after breast conservation surgery was used in 44% of the cases, but was almost twice as likely to be used if the tumours were > 5 mm (51%) than if the tumours were >5 mm (29%). Adjuvant tamoxifen was given to 61% of the cases. Conclusions: We found that small invasive breast cancers are commonly treated by breast conservation, which usually includes axillary dissection. Even the smallest may be node‐positive, and there is uncertainty about the place of adjuvant radiation therapy and tamoxifen.
MODERATE HEAD INJURY: A SYSTEM OF NEUROTRAUMA CARE
Authors: Fearnside Michael , Mcdougall Patricia 
Published: January 2008

Background: The aim of the present study was to determine those factors which contribute to a poor outcome and to propose a management plan that is complementary to trauma systems in common use. Methods: A prospective study of 110 consecutive patients with moderate head injury (post‐resuscitation Glasgow Coma Scale (GCS) 9–13) was carried out. Results: A total of 75% of the patients sustained multisystem trauma, generally of minor or moderate grade according to the Abbreviated Injury Scale (AIS). However, the death rate increased with the severity of the injury as measured by the Injury Severity Score (ISS). The initial cranial computed tomography (CT) scan was abnormal in 61% and no patient with a normal scan developed a delayed intracranial haematoma or neurological worsening. Those patients who developed a delayed intracerebral haematoma had a worse outcome. Sixteen patients underwent craniotomy for haematoma. The intracranial pressure (ICP) was measured selectively in 20 patients and exceeded 20 mmHg in half, requiring treatment. Nine patients died, four as a result of head injury and all those had an intracranial haematoma. As a group, those who died were older and had a higher ISS. Conclusions: A plan for care of patients with moderate head injury is proposed, complementary to the Early Management of Severe Trauma (EMST) protocol and the Neurosurgical Society of Australasia guidelines for neurotrauma management in rural and remote locations.
STUDIES OF THE SURGICAL SCRUB
Authors: Poon Christopher , Morgan David J. , Pond Franklin , Kane John , Tulloh Bruce R. 
Published: January 2008

Background: To evaluate the effectiveness of various scrub techniques in reducing bacterial skin flora, the present study was developed in three stages. Methods: Each stage involved fingertip bacterial colony counts measured before, immediately after and 30 min after a variety of handwashing techniques using 10% povidone iodine solution. The first compared 1, 2 or 3 non‐timed washes from fingertips to elbows in 10 volunteers. The second compared two volunteers scrubbing for equal durations with or without friction rubbing, while the third involved 15 volunteers who each scrubbed for different time intervals. Results: The first stage showed that a single wash episode failed to provide lasting bacterial colony count reductions on fingertip cultures. The second showed that enduring colony count reductions occur whether friction rubbing of the hands was used or not, and the third showed that a 30 s wash was as effective as washing for longer periods in reducing fingertip flora. Conclusions: These findings suggest that prolonged vigorous pre‐operative scrubbing is unnecessary, although more than a cursory wash is required to produce lasting fingertip antisepsis.
COMPARATIVE EXPERIENCE OF A SIMPLE TECHNIQUE FOR LAPAROSCOPIC CHRONIC AMBULATORY PERITONEAL DIALYSIS CATHETER PLACEMENT
Authors: Draganic B. , James A. , Booth M. , Gani J. S. 
Published: January 2008

Background: Chronic ambulatory peritoneal dialysis (CAPD) is now an established technique for renal dialysis. Patients with renal failure cope poorly with major surgery and it is vital that the dialysis catheter tip is sited accurately in the pelvis if long‐term catheter function is to be achieved. Laparoscopic placement of CAPD catheters may have potential advantages for renal patients by avoiding the morbidity of a laparotomy. Methods: A retrospective audit was performed of all CAPD catheters inserted at the John Hunter Hospital over a 2‐year period. Results of laparoscopically inserted catheters and those placed at laparotomy were compared. Results: Sixty catheters were inserted, 30 laparoscopically and 30 at laparotomy. The mean operative time was 41 min in the laparoscopic patients and 57 min in the laparotomy patients (P= 0.0001). The mean total dose of narcotic administered postoperatively was significantly less in the laparoscopic group (5 mg vs 65 mg, P= 0.00002). There were three minor peri‐operative complications in the laparoscopic group and seven peri‐operative complications in the laparotomy group, three required reoperation and one resulted in the patient'death. There were no significant differences in the incidence of exit‐site infection, catheter blockage, peritonitis, and overall catheter survival, although the laparoscopically placed catheters had been followed up for a shorter period (10 vs 16 months). Conclusions: This laparoscopic technique is safe and effective. Postoperative pain was less than for open placement. Laparoscopically placed catheters had a low incidence of peri‐operative complications. Medium‐term patency is similar to conventionally placed catheters. This procedure requires no additional equipment to that available for laparoscopic cholecystectomy and takes less time than the open operation.