bluuebunny/crossref_metadata_2025_split huggingface dataset:
GS08 ANASTAMOTIC LEAK RATES FOR COLORECTAL CANCER RESECTION IN A REGIONAL BASE HOSPITAL
Authors: Yang S. M. , Franz R. , Morrissey D. 
Published: April 2007

Purpose  Colorectal cancer (CRC) is the most frequently reported malignancy in Australian cancer registries. A large proportion of these cancers are managed by general surgeons with no specific sub‐specialist training. Our study aims to examine anastamotic leak rates after surgery for CRC in a regional hospital, performed by non sub‐specialty trained general surgeons and to compare this data with those of other specialist colorectal units.Method  An audit of all patients treated for colorectal cancer at Toowoomba Base Hospital between 1 January 1990 and 1 April 2006 was undertaken. An anastamotic leak was defined as a clinical diagnosis documented in the patients’ medical chart or operative report.Findings  580 patients were treated for colorectal cancer during the prescribed period. Of these, 444 had surgery which included a gastrointestinal anastamosis. There were 13 anastamotic leaks (2.9%). The following commonest procedures had respective leak rates of: right hemicolectomy 2.2%; anterior resection 2.2%; sigmoid colectomy 3.28%; ultra‐low anterior resection 6.67%. Of the 13 leaks, 1 occurred in Dukes A cancers (1.89%), 9 in Dukes B cancers (4%) and 3 in Dukes C cancers (1.5%).Conclusion  The anastamotic leak rates over the past 16 years at Toowoomba Hospital appear to be comparable to those of other specialist colorectal surgical units. It may be that leak rates are more dependent on the quality of the individual surgeons performing the procedure and the soundness of their surgical techniques, irrespective of their level of sub‐specialization. However, research needs to be done to prospectively compare the leak rates of different surgical units before further conclusions can be made.
HS03 BOTULINUM TOXIN A IN THE UPPER LIMB IN CEREBRAL PALSY
Authors: Johnstone B. R. , Coombs C. , McCombe D. , Duncan J. 
Published: April 2007

Purpose  To evaluate patients with cerebral palsy treated with botulinum toxin A injections to assist with the management of contracted muscles and joints as well as co‐contraction.Methods  Since 1998, 40 limbs have been treated. The average age was 14 years (range 4 to 33 years) and the average dose given was 107 units (range 50 to 200 units). Digital flexors were injected in 26 limbs, elbow flexors in 18, wrist flexors in 17, thumb adductors in 13, pronator teres in 9, intrinsics in 3, shoulder abductors in 2 and ECU in one limb. All patients were injected under a general anaesthetic, allowing for an assessment of fixed contractures. Padded plaster casts were applied, putting the injected muscles on full stretch before the reversal of anaesthesia and were maintained for approximately 3 weeks. Thermoplastic splits were then wore 23 hrs per day for a further three weeks. Splints were serially modified to achieve progressively more extension as the flexion contractures were corrected. Simultaneous surgical procedures such as tendon lengthening and transfers were performed in 14 limbs.Results  The results in the elbow flexors were disappointing. The finger, thumb and wrist flexors have responded extremely well, despite fixed flexion deformities being documented under anaesthesia in the majority of patients.Conclusion  It is estimated that the muscle bellies have been elongated by 3 to 4 cm either by the lengthening of, or addition to the sarcomeres.The results in these patients are vastly superior to that which could be obtained surgically.
HS07 TOE TRANSFER – TECHNIQUES & RESULTS
Authors: Teoh L. C. 
Published: April 2007

Toe to thumb‐finger transfer requires the understanding of microsurgery and reconstructive technique. The success is measured by the viability of the toe and eventually recreating the function of the original loss.In harvesting of the toe, the big and second toe follows almost the same technique. Identifying the toe artery over the first web space and then dissecting proximally into the intermetatarsal artery is the best approach. To dissect the artery from proximal to distal is often fraught with many dangers. In my cases about 50% the plantar artery is dominant. Anticipation and planning of the artery length is crucial.In toe to thumb transfer the choice can be 2nd toe, total big toe, trimmed big toe or wrap around transfer. In our local populations, 2nd toe is always a good choice. First reconstruction with flap resurfacing may be necessary if the thumb amputation is very proximal.Toe to fingers transfer is usually indicated in 4 finger loss of the hand. In toe to finger transfer I prefer the two 2nd toes transfer into the middle and ring finger position. As the transferred toes can regain less that 50% of motion, the positioning of the toes should be opposable to the thumb.The concept of total reconstruction should be closely followed. Stable skeletal fixation, tendon weave technique, good nerve repair, adequate skin coverage and primary healing are important to ensure good outcome result.
HN01 LARGE PERI‐AURICULAR CARCINOMA RESECTION WITH KEYSTONE DESIGN PERFORATOR ISLAND FLAP (KDPIF)
Authors: Keane H. J. , Yuen A. , Park A. , Behan F. , Sizeland A. 
Published: April 2007

Large peri‐auricular carcinoma resection with Keystone Design Perforator Island Flap (KDPIF)Purpose  Due to the surrounding anatomy, peri‐auricular tumours can be difficult surgical resections and reconstructions. Acceptable resection margins may be difficult to obtain while trying to retain vital structures. The aim of this study was to analyse extent of surgery, pathological findings and adjuvant therapy, and how they impact on outcome and survival.Methodology  Patients with squamous cell, basal cell, melanoma and other of the peri‐auricular area were reviewed that underwent large surgical resection and reconstruction with KDPIF. Outcomes were defined as mortality, recurrence and flap failure. Patients were followed for a minimum of 2 years.Results  This series contained 100 patients, 69% were squamous cell carcinoma. Median age was 76 years. All underwent radical surgical resection involving either parotidectomy/other procedure with/without bone removal, and KDPIF reconstruction. 31% had positive margins, 26% had a neck dissection and 60% had post‐op radiotherapy and/or chemotherapy. Mortality from disease at 2 years was 9%.Conclusion  Our results suggest that a positive pathological margin is not an independent predictor for poor disease control as suggested by O’Brien et al, and that despite advanced age and disease, this population achieved low recurrence and high survival rates.
HN10P METASTATIC CUTANEOUS SQUAMOUS CELL CARCINOMA TO THE PAROTID GLAND
Authors: Watts G. D. , Ioannoni B. , Sader C. , Kuan R. 
Published: April 2007

Purpose  With an incidence rate of 300 cases per 100000 population per year, Australia has the highest incidence of cutaneous squamous cell carcinoma (SCC) in the world. Metastatic cutaneous SCC in parotid lymph nodes are aggressive tumours with poor outcomes both in terms of local control and survival.Methodology  This study reports a prospective series of 41 consecutive patients with metastatic SCC to the parotid gland in a major teaching hospital in Western Australia over a six‐year period from January 2000 to December 2005. Epidemiological, clinical, histopathological and treatment details along with patterns of failure were extracted from the database. The survival and failure curves were calculated using the Kaplan‐Meier method. Univariate and multivariate analysis were performed using Cox regression method.Results  The five‐year absolute survival is 34.2% and the cancer specific survival 39.5%. Local failure was observed in 11 patients for an actuarial rate of local disease free survival of 65.8% at 6 years. Distant failure occurred in two patients for an actuarial distant disease free survival of 89.5% at 6 years. Both univariate and multivariate analysis failed to find any predictors of local or distant failure with statistical significance.Conclusions  Multimodality treatment will still fail to locally control or cure at least a third of patients. Previously identified risk factors were not substantiated in this study and may relate to patient numbers. Parotidectomy and post‐operative radiotherapy remain the gold standard. Unlike their cutaneous counter parts metastatic SCC to the parotid gland remains an aggressive tumour with current treatment regimes.
HN11P PRIMARY CHEMO‐RADIOTHERAPY FOR NON‐METASTATIC SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
Authors: Streit J. B. F. , Gao K. , Obrien C. , Boyer M. , Milross C. 
Published: April 2007

Purpose  To review our experience of concomitant single agent cheoradiotherapy treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN).Methodology  A retrospective cohort study of 56 patients with advanced SCCHN. Patients were eligible for inclusion if they had been treated with primary concurrent chemoradiotherapy for squamous cell carcinoma of the oral cavity (p = 7%), oropharynx (p = 54%), larynx (p = 23%) or hypopharynx (p = 16%) at the Sydney Head and Neck Cancer Institute between 2000 and 2005. Patients treated previously for this disease, or with other agents (such as 5‐FU) in combination with cisplatin/carboplatin, were excluded. Treatment was 80 or 100 mg/m2 of cisplatin in weeks 1, 4 and 7 of radiotherapy. Percutaneous endoscopic gastrostomy (PEG) feeding tubes were placed in 86% of patients.Results  A 90% initial complete response rate was observed. The Kaplan‐Meier 3 year projected overall survival rate was 72% and 3‐year disease specific survival was 74%. Eleven percent of the patient cohort underwent salvage surgery while 14% required chemotherapy dose adjustments. Twenty percent of patients required unplanned hospital admission for the management of treatment related toxicity.Conclusion  Our study affirms that our overall survival rates and treatment related toxicities, using a concomitant chemoradiotherapy protocol are comparable with other institutions. Our initial clinical response rates may reflect our selection criteria and the low percentage of patients requiring dose adjustments. Our low rate of unplanned hospital admissions may be explained by the routine use of PEG tubes to reduce treatment related complications.
HN03 METASTATIC PAROTID SQUAMOUS CELL CARCINOMA: A FACIAL NERVE PRESERVATIVE APPROACH
Authors: Keane H. , Park A. , Sizeland A. , Yuen A. 
Published: April 2007

Purpose  Metastatic squamous cell carcinoma is the most common parotid malignancy in Australia. Excising the primary carcinoma with parotidectomy of involved lymph nodes is a potentially curative option.Methods  Retrospective audit of one surgeon’s experience in a ten year period was carried out to validate the approach. Analysis of recurrence and survival was carried out.Results  We looked at 183 patients ages ranging from 43–98 (Av age 77.7, SD 11.1, Mean 80). 169 (92%) underwent primary resection, 15 (8%) had palliative radiotherapy. Of the surgical group, 53 were T1, 80 were T2, 14 were T3 and 20 were T4, with two patients staged as Tx. At surgery, 20 (12%) had facial nerve sacrifice. For patients 2 years post surgery, the disease free survival was 53%, with mean time to recurrence 386 days. Patients with facial nerve sacrifice recurred locally in 34% of cases with mean time to recurrence of 281 days, those with facial nerve preservation recurred in 23% with mean time to recurrence 416 days. We found patients with node negative necks had recurrence in 18% (31% node positive) and mortality of 15% (vs 28% node positive).Conclusion  In spite of elderly mean age and large number of patients with advanced disease we achieved very high local control and survival rates. Preserving the facial nerve except when passing through cancer resulted in no decrease in local control or survival. Nodal disease was a predictor of prognosis in contrast to previous studies.
HN07P CLINICAL EXAMINATION OF THE NECK IN FLOOR OF MOUTH CANCER
Authors: Anderson S. R. , Coman W. 
Published: April 2007

Purpose  To evaluate the sensitivity and specificity of clinical examination for cervical lymph node metastasis in patients with floor of mouth (FOM) squamous cell carcinoma (SCC). Comparison will be made to published data on other modalities used to investigate cervical metastasis.Methodology  A retrospective chart audit was conducted and 53 patients with FOM SCC were included in this cohort. Clinical examination was performed at the initial consultation and from this a TNM stage was established. This was compared to histology reports from operative specimens and the sensitivity and specificity for clinical examination calculated.Results  Clinical examination alone for FOM cancer has a sensitivity and specificity of 72% and 77% respectively. The incidence of clinically occult disease in this cohort was 22%.Conclusion  Failure to detect and treat occult cervical metastasis significantly affects recurrence and survival. Clinical examination alone failed to detect a significant percentage of cervical metastasis in this cohort. Radiological modalities may improve the detection of clinically occult disease. However, neck dissection and histological examination remains the ‘gold standard’ as a therapeutic and diagnostic tool.
HP13 COMPLICATIONS OF DUODENAL DIVERTICULAE: A REPORT OF FIVE CASES
Authors: Al‐Mozany N. , Rodgers M. S. 
Published: April 2007

Purpose  To review the incidence, acute presentations and management of duodenal diverticulae presenting to North Shore Hopsital, Auckland, New Zealand.Methodology  We present five cases of complicated duodenal diverticulae presenting over the period of 2005 to 2006. We reviewed 1622 consecutive ERCP reports at our institution to determine the endoscopic incidence.Results  The endoscopic incidence of reported duodenal diverticulae was approximately 13%. Five cases of severe complicated duodenal diverticulae presented over a 12 month period. There were 3 men and 2 women aged 48 to 83. These included 3 cases of free perforation, 1 of contained perforation and 1 of recurrent severe pancreatitis. The free perforations were treated with emergent surgery including a pancreaticoduodenectomy and 2 excisions and primary closure. The contained perforation was managed conservatively. The patient with severe pancreatitis required a pancreaticoduodenectomy. There were significant complications but all patients survived and have resumed normal diets.Conclusion  Complications of duodenal diverticulae are diverse and may be severe. Timely surgical intervention results in good outcomes.
HP15 SURGERY FOR CHRONIC PANCREATITIS: EXPERIENCE AND TRENDS IN AUCKLAND
Authors: Windsor J. A. , Veersingam P. , Quistorff D. 
Published: April 2007

Purpose  There has been uncertainty, if not skepticism, about the role of surgery for chronic pancreatitis (CP) in New Zealand. The aim of the study was to review the indications, operations and outcomes for this type of surgery.Methodology  All patients with CP managed by the HBP/Upper GI Unit (Auckland City Hospital) and by HBP/Upper GI Surgeons Ltd (Mercy Integrated Hospital) between 1999 and 2006 were identified by audit systems and the clinical records were reviewed. Outcome was determined by a separate telephone survey using a derivative of validated questionnaires.Results  From the 1499 admissions of 1092 patients, there were 81 (7%) patients (median age 44 years, range 11–76, male : female 1.7 : 1) who had surgery. The Japan Pancreas Society criteria determined that 64 patients had definite CP (9 with cancer), 10 with probable CP, and 7 without evidence of CP (2 with cancer). ERCP was performed in 41 (50%) patients (20 diagnostic and 21 therapeutic procedures, 11 had pancreatic stenting as a therapeutic trial). There were 42 resections (right side 24, left side 18) and 32 decompressions (Frey 29, Partington‐Rochelle 3) and 7 cysto‐enterostomies. There was no 30 day mortality, a major complication rate of 5% and an overall median hospital stay of 12 days (range 2–82). The results for long‐term clinical outcome demonstrated sustained benefit in the majority of patients.Conclusions  Surgery for CP can be performed safely and with sustained clinical benefit in a carefully selected and small subgroup of patients.
HP16 NEGATIVE PRESSURE WOUND THERAPY [NPWT] IN POSTOPERATIVE PANCREATIC FISTULA: A NOVEL APPROACH
Authors: Shelat V. , Diddapur R. 
Published: April 2007

Incidence of postoperative pancreatic fistula can be as high as up to 25%, especially when operating on a soft pancreas with non‐dilated pancreatic duct.1 Pancreatic fistula is usually managed expectantly. NPWT is a new dressing method for wound care. NPWT has been used for enterocutaneous fistulas.2 Use of NPWT in managing pancreatic leak is a novel approach and as yet unreported.Aim  We propose the use of NPWT in selected cases of postoperative low output external pancreatic fistulas.Case Report  47‐year‐old male was diagnosed with mucinous cystic neoplasm of pancreas. He had three surgeries in past for choledochal cyst and developed an incisional hernia. He underwent Whipple’s procedure. He developed a polymicrobio‐fungal wound infection. On post‐operative day 7 he developed a low output pancreatic leak with wound fluid amylase of >15,000 units. He was managed with NPWT at 50 mmHg pressure. The dressing was changed by wound care nurse every 48 hours.Result  The pancreatic leak settled in 5 days after the use of NPWT. There was no skin excoriation and wound discomfort. NPWT was continued in view of wound infection. Wound granulated well.Conclusion  NPWT can be used successfully in postoperative low output external pancreatic fistulas. Use of NPWT has to be explored further before recommending it routinely and for use in high output pancreatic fistulas.
HP17 COMMON BILE DUCT STONES: A REVIEW OF MANAGEMENT OPTIONS
Authors: O’Neill C. J. , Gillies D. M. , Gani J. S. 
Published: April 2007

Purpose  Two recent meta‐analyses support operative CBD exploration (laparoscopic or open) as at least equal to ERCP for the management of choledocholithiasis with the gall bladder in situ. The literature regarding laparoscopic exploration is largely from enthusiasts and may not be transferable across institutions. In our institution both hepatobiliary and general surgeons perform cholecystectomy with variable comfort levels with laparoscopic CBD exploration. ERCP and laparoscopic antegrade transampullary biliary stents are available. We review the management of choledocholithiasis in this setting.Methods  A retrospective review of all patients who underwent cholecystectomy during 2004 and 2005 at two Newcastle hospitals was conducted.Results  The incidence of choledocholithiasis was 10.3% (70 patients). This was diagnosed pre‐operatively in 36 patients; 22 underwent pre‐operative ERCP (62.5% clearance) and 14 operative CBD exploration (100% clearance). An additional 22 patients with presumed choledocholithiasis had a normal cholangiogram at pre‐operative ERCP. Operative cholangiogram first confirmed choledocholithiasis in 31 patients; CBD exploration was successful in 58.8% (10 of 17). Intra‐operative biliary stents were inserted in 15 patients due to a small calibre CBD, failed exploration or lack of equipment and time for exploration. Hepatobiliary surgeons more frequently performed operative CBD exploration and stent placement.Conclusion  The management of choledocholithiasis varies with the clinical scenario and local expertise. This series defines a role for intra‐operative stent placement, suggests pre‐operative ERCP is over‐utilised, and that operative CBD exploration is successful with low morbidity.
HP22 FIVE YEAR RESULTS OF A PROSPECTIVE RANDOMISED CONTROLLED TRIAL OF ARGON PLASMA COAGULATION VS ENDOSCOPIC SURVEILLANCE OF PATIENTS WITH BARRETT’S OESOPHAGUS AFTER ANTIREFLUX SURGERY
Authors: Ackroyd R. , Wijnhoven B. , Astill D. , Watson D. , Bright T. F. 
Published: April 2007

Background  Argon plasma coagulation (APC) has been used to ablate Barrett’s oesophagus, although the long‐term efficacy is unknown. This study reports the 5 year results of APC ablation vs surveillance of Barrett’s in post‐fundoplication patients.Methods  43 post‐fundoplication patients with Barrett’s oesophagus were randomised to either APC ablation of Barrett’s or surveillance. 40 have been followed up with endoscopic surveillance for a mean of 68 months to assess treatment efficacy, safety and the durability of the neosquamous re‐epithelialisation.Results  A median of 2.5 (range 1–6) APC treatment sessions was required to reach >95% ablation of Barrett’s. Both groups had a significant (p < 0.0001) reduction in Barrett’s length over the duration of follow‐up, with APC patients having significantly greater length reduction of Barrett’s at last endoscopy compared to the surveillance group (p = 0.0277). At 68 months, 14 of 20 APC patients (70%) continued to have >95% ablation of their Barrett’s, with 8 of 14 (57%) having no macroscopic or histologic evidence of Barrett’s. 4 of 20 surveillance patients (20%) had complete reversal of their Barrett’s, with 3 of 4 (75%) having no macroscopic or histologic evidence for Barrett’s. 2 patients in the APC group developed strictures requiring dilation. 2 patients in the surveillance group developed HGD during follow‐up, while none did in the APC group.Conclusions  40% of post‐fundoplication patients with APC ablation of Barrett’s retain this reversal beyond 5 years. 20% of Barrett’s patients post‐fundoplication regress to normal squamous mucosa. Post‐fundoplication Barrett’s surveillance patients continue to develop HGD, this has not been seen in the APC group.
HP29P RECURRENT HEARTBURN AFTER FUNDOPLICATION WITH A NEGATIVE 24‐HR PH ASSESSMENT: RECURRENT REFLUX OR “IRRITABLE OESOPHAGUS”?
Authors: Thompson S. K. , Jamieson G. G. , Myers J. C. , Parr Z. , Devitt P. G. 
Published: April 2007

Purpose  A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Over two thirds will have a negative 24‐hr pH study. Our objective is to determine whether these patients have a functional disorder. We are therefore first confirming that there is no recurrent reflux and then investigating whether they have altered cytokine levels and symptomatic relief from an herbal medicine, Iberogast ®. Patient recruitment is ongoing and this report documents the reproducibility of 24‐hr pH testing in this group of patients.Methodology  A prospective analysis has been carried out on a cohort of patients (identified from the Royal Adelaide Hospital Oesophageal Function database) who have undergone a fundoplication and pH testing for recurrent heartburn. Group A: patients with recurrent heartburn and a negative 24‐hr pH study. Group B (control group): patients with recurrent heartburn and a positive pH study (treated with medication/surgery; asymptomatic). As part of the study, Group A patients were asked to complete a 2nd post‐operative 24‐hr pH test.Results  159 patients were identified from our database, and 138 patients met our inclusion criteria. 91/138 (66%) patients have agreed to participate. 36/38 Group A patients (95%), who have thus far completed a repeat 24‐hr pH study, had a negative result. Symptom‐reflux correlation was highly significant (P < 0.001).Conclusions  Reproducibility of 24‐hr pH testing in patients with recurrent heartburn and a negative 24‐hr pH study is excellent (95%) and seems better than the 70–80%, which is the usually quoted figure for this test. Therefore, a 2nd pH test to confirm initial results will be unnecessary in most patients.