bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREVENTABLE TRAUMA DEATHS IN SINGAPORE
Authors: Iau Philip T. C. , OngSteven C. L. , Chan T. F. 
Published: January 2008

Background: This study was undertaken to determine the incidence of preventable trauma death at a non‐designated trauma centre in Singapore. Methods: A retrospective audit was carried out on all trauma deaths that occurred between January 1993 and December 1994 at the National University Hospital, Singapore. Of the 138 deaths, 38.4% (53/138) of patients were dead on arrival and were omitted from the study. Data from the remaining 85 deaths were summarized and presented before a multidisciplinary review board and injuries were scored according to the Abbreviated Injury Scale (AIS). Results: Except for one patient, all deaths had an AIS score of 16 or greater. Sixty‐one per cent (52/85) of deaths were the result of severe head injuries, and the rest had severe injuries in more than one body region. Following the guidelines of the Trauma Research and Education Foundation of San Diego, the incidence of ‘not preventable’, ‘potentially preventable’ and ‘frankly preventable’ deaths were 77.6, 15.3 and 7.1%, respectively. The most common errors in management were caused by delays in inter‐departmental transfer (25.9%) and missed initial diagnosis (16.5%). After assessment by the Coroner'Office, autopsies were carried out in 60% of the cases and yielded information that altered the assessment of preventable deaths, particularly in the group with multiple injuries. Conclusions: The present study concludes that the preventable death rates in the National University Hospital are comparable to those in non‐trauma designated centres elsewhere. There can only be a decrease in the preventable death rate if an improved system of pre‐hospital trauma care, improved interdisciplinary communication, closer supervision of the initial attending physicians and stricter protocols on clinical monitoring are established.
PREDICTORS OF LENGTH OF STAY FOR TRANSURETHRAL PROSTATECTOMY IN VICTORIA
Authors: Ansari M. Z. , MacIntyre C. R. , Ackland M. J. , Chandraraj E. , Hailey D. 
Published: January 2008

Background: Transurethral resection of prostate (TURP) is among the top 10 surgical conditions that account for hospital admission in Victoria. Bed utilization for TURP is an increasing concern in current times. This paper describes trends in length of stay (LOS) and identifies predictors of LOS for TURP in Victoria. Methods: Trends in TURP were studied using ICD‐9‐CM coded Victorian hospital morbidity data from public hospitals from 1987/88 to 1994/95. Detailed morbidity data from the same source for the financial year 1995/96 were used to study predictors of LOS by logistic regression. Results: Length of stay decreased significantly between 1987 and 1995 from 10.6 to 6.1 days. The strongest predictor of increased LOS was admission through the emergency room (odds ratio (OR) 14.7; 95% confidence interval (CI) 11.8–18.3). Other significant predictors were older age, lower socio‐economic status, presence of comorbid conditions, occurrence of procedural morbidity, and hospital type and location. Conclusions: The trend in decreasing LOS may be explained by increasingly efficient bed management in hospitals who are faced with an increasing need for cost control. Advances in surgical techniques and peri‐operative care have also contributed to the decrease in LOS. Other factors that influence LOS can be divided into three categories: intrinsic patient factors, such as co‐morbid conditions; procedure‐specific factors such as peri‐operative morbidity; and intrinsic hospital factors relating to capacity and resources. Such determinants of LOS may be of value to policy makers when considering the effective application of newer methods for treatment of benign prostatic hyperplasia.
CYSTIC TUMOURS OF THE PANCREAS: A DIAGNOSTIC DILEMMA
Authors: Ooi L. L. P. J. , Ho G. H. , Chew S. P. , Low C. H. , Soo K. C. 
Published: January 2008

Background: Cystic neoplasm of the pancreas is an uncommon entity that encompasses a range of tumours with varying potential for malignancy. These tumours are frequently misdiagnosed as pseudocysts and are inappropriately managed. Methods: A retrospective review was undertaken of 18 cases of cystic tumours of the pancreas over an 8‐year period in two large hospitals in Singapore. Results: All patients were Asian, with a younger age group (mean 43.5 years) and a lesser degree of female predominance (3.5:1 ratio) compared to other series. Pain was the most common symptom. Pre‐operative diagnosis using ultrasound and computed tomography was not diagnostic in half of the cases and misdiagnosed as pseudocyst in a sixth. There were five serous cystadenomas, four mucinous cystadenomas, two mucinous cystadenocarcinomas, one mucinous cystadenocarcinoma with cystic degeneration in a ductal adenocarcinoma, three Frantz tumours, one acinar cell tumour, one glucagonoma, and one benign epithelial cyst. Two‐thirds of tumours were malignant or had the potential to become malignant. Resection was curative in all cases, and no recurrence was noted at a mean follow‐up of 34.5 months. Conclusions: The difficulties with pre‐operative diagnosis, the high incidence of tumours with potential malignancy, and the good outcome with resection, suggest that all suspected cystic tumours of the pancreas should be resected.
RE‐OPERATIVE SURGERY FOR RECURRENT OR PERSISTENT PRIMARY HYPERPARATHYROIDISM
Authors: Wadström C. , Zedenius J. , Guinea A. , Reeve T. S. , Delbridge L. 
Published: January 2008

Background: While initial surgery for primary hyperparathyroidism, in experienced hands, will result in a cure in 98% of cases, re‐operative surgery remains a significant challenge. Because attitudes as to who should perform initial exploration for hyperparathyroidism are significantly different around the world, the approach to re‐operative surgery may also vary. The aim of the present study was to examine a local experience of re‐operative surgery for recurrent or persistent primary hyperparathyroidism. Methods: Information on indications for surgery, the procedure performed, pathology and complications of all re‐operative procedures for primary hyperparathyroidism in the period January 1962 to December 1996 were obtained from a prospective database. Results: Sixteen patients with persistent (n= 12) or recurrent (n= 4) primary hyperparathyroidism were treated in the unit over the study period. Eight patients had their initial operation within the unit at Royal North Shore Hospital and eight were referred from elsewhere for re‐operation. Nine of the 12 patients with persistent hyperparathyroidism were cured by re‐operation with failures due to spillage at first operation (n= 1) or failure to find any additional pathology (n= 2). All four patients with recurrent hyperparathyroidism were cured. All the failures occurred early in the learning phase of the unit, with a 100% cure rate for re‐operative procedures performed in the last 15 years. The most common finding in patients referred from elsewhere with a failed initial operation was a missed inferior adenoma in association with the thymus. Localization studies had a variable sensitivity, with sestamibi scintigraphy, selective venous sampling and ultrasonography providing the most reliable information. Conclusions: Re‐operative surgery for persistent or recurrent hyperparathyroidism is an uncommon procedure in Australia when compared to major centres in the USA. Successful surgery depends upon experience and an accurate knowledge of the embryology and anatomy of the parathyroid glands.
ACUTE COLONIC PSEUDO‐OBSTRUCTION
Authors: Alwan Majeed H. , Rij André M. van 
Published: January 2008

Background: Acute colonic pseudo‐obstruction is an acute non‐mechanical colonic obstruction. Twenty patients with this condition presenting between 1988 and 1996 were retrospectively reviewed to identify the incidence and potential aetiologic factors, and to establish a uniform therapeutic approach. Methods: Patients who fulfilled the criteria of acute pseudo‐obstruction of the colon were reviewed retrospectively from a computerized database, and from a study of the hospital notes. Results: There were 12 men and eight women with a median age of 71 years. Seventeen patients (85%) had various coexisting medical conditions, and none of the cases had a recent surgical operation or trauma. Four patients had previous similar attacks. Patients had a median duration of symptoms and a hospital stay of 3 and 7 days, respectively. Diagnosis was based on the clinical features coupled with the findings on plain abdominal X‐rays and contrast enema. Sixteen patients were successfully treated conservatively over a median time of 5 days. Three patients had a laparotomy: two patients had tube caecostomy (followed by complications), and one patient had no further treatment. One patient had colonoscopy with an unsatisfactory result. Two patients (10%) died and three (15%) developed complications. Conclusions: Acute colonic pseudo‐obstruction is an uncommon but serious condition. The majority of our patients (17/20) had associated significant medical problems. Most of the patients were successfully managed conservatively. This was the preferred initial line of treatment in this department during the study period.
RECTAL CANCER FOLLOWING COLECTOMY AND ILEORECTAL ANASTOMOSIS FOR FAMILIAL ADENOMATOUS POLYPOSIS
Authors: Jenner D. C. , Levitt S. 
Published: January 2008

Background: Familial adenomatous polyposis (FAP) has historically been treated by colectomy and ileorectal anastomosis (IRA). Preservation of the rectum allows the subsequent development of cancer in the rectum. The risk of rectal cancer following ileorectal anastomosis in the Australian population has not been published to date. Methods: An audit of the Familial Adenomatous Polyposis Registry of Western Australia was undertaken to assess patients who had undergone colectomy and ileorectal anastomosis. Fifty‐five patients ranging in age from 13 to 65 years were studied. Results: Seven patients (13%) developed cancer of the rectum with a median follow‐up of 10 years (range: 1–31 years). Median interval to diagnosis of carcinoma of the rectum following colectomy and IRA was 10 years. All patients who developed cancer in the retained rectum had rectal polyps. Colon cancer was present in the initial colectomy specimen in 13 patients (of these, five patients developed rectal cancer). Flat polyps were noted in five patients. Four patients with flat polyps developed cancer of the rectum. Conclusions: Total colectomy and IRA should be considered as part 1 of a staged procedure in the patient with FAP. With the exception of the patient with no evidence of rectal polyps, completion proctectomy should be undertaken within 10 years of the initial colectomy.
THE TECHNIQUE OF ENDOSCOPIC EXPLORATION FOR PARATHYROID ADENOMA OF THE NECK
Authors: Yeung Gustus H. C. , Ng Jacob W. T. 
Published: January 2008

Background: The technical details of endoscopic exploration of parathyroid adenoma are described here, thereby drawing attention to the enormous potential of this new modality of minimal‐access surgery. Methods: Four patients with a parathyroid adenoma that was clearly demonstrated by pre‐operative localization imaging techniques were subject to endoscopic exploration using one 11 mm and two 5 mm ports: a technique heretofore undescribed. Results: An adenoma was successfully localized endoscopically in each case and was removed. The postoperative outcome proved most encouraging: no analgesics were required, the hypercalcaemia rapidly corrected and the patients were pleased with the smallness of scars. Conclusions: The described endoscopic approach is a viable and promising alternative to open surgery for parathyroid adenoma; further study would be fruitful.
NM23 GENE EXPRESSION IN GASTRIC CARCINOMA: AN IMMUNOHISTOCHEMICAL STUDY
Authors: Yeung P. , Lee C. Soon , Marr P. , Sarris M. , Fenton‐Lee D. 
Published: January 2008

Background: The gene Nm23 is thought to play a role in the suppression of tumour metastasis. Reduced expression of Nm23 is seen in a number of human cancers, and is associated with increased metastasis and reduced survival, most strongly in ductal breast and colorectal carcinomas. Methods:
Nm23 gene expression was compared in gastric carcinoma and normal gastric mucosa. Twenty‐three gastric carcinomas were graded for differentiation as either well, moderately or poorly differentiated. Metastatic deposits from seven of the cases were also examined, along with 10 samples of normal gastric mucosa. Specimens were incubated with a murine monoclonal antibody against the protein product of Nm23, and examined by immunohistochemical staining. A semiquantitative immunostaining index was used. Results: All normal mucosa showed moderate to strong staining; 8 of 15 poorly differentiated carcinomas showed absent or weak staining; 1 of 6 moderately differentiated carcinomas stained weakly. Both well‐differentiated carcinomas stained strongly; 1 of 7 metastatic deposits stained weakly. The difference in Nm23 expression between normal mucosa and carcinomas was statistically significant (P= 0.024). However, there was no statistically significant difference between the three grades of carcinomas (P= 0.51), or between primary and metastatic tumour (P= 0.25, all by Chi‐squared test). Conclusions: These results suggest that Nm23 may have a role in gastric carcinoma pathogenesis, but do not show a correlation with metastasis. A larger study, involving detailed clinical staging and follow‐up, may be of benefit.
LATEX ALLERGY IN NON‐SPINA BIFIDA PATIENTS: UNFAMILIAR INTRA‐OPERATIVE ANAPHYLAXIS
Authors: Burrow Greggory H. , Vincent Kent A. , Krajbich J. Ivan , Aiona Michael D. 
Published: January 2008

Background: The medical literature has described the prevalence of latex allergy in the spina bifida population and its implications for surgical intervention. We report three cases of severe and unexpected intra‐operative anaphylaxis secondary to latex exposure in non‐spina bifida patients. Methods: A retrospective review of case notes identified three non‐spina bifida patients who suffered intra‐operative anaphylaxis due to latex allergy. Personal and telephone interview and patient chart review was performed to detail a past history of multiple latex exposure, atopy, the anaphylaxis event and the postoperative outcome. Results: Three non‐spina bifida patients are described. One suffered a cardiopulmonary arrest, the remaining two patients had severe vascular hypotension and airway resistance that was only relieved after administration of vasoconstrictors and bronchodilators. Postoperatively, all three tested strongly positive to latex allergen testing. Each patient had a history of multiple surgical latex exposure and specific allergies or allergic‐type symptoms pre‐operatively. Conclusion: We believe that the predictors of a severe allergic reaction to latex with surgical exposure in non‐spina bifida patients may be similar to those predictors known in the spina bifida population. Identification of such at‐risk patients will reduce the risk of significant intra‐operative morbidity and possible mortality by the introduction of a latex‐free operating environment.
A CLINICAL COMPARISON OF ARTERIAL AND ATRIAL REPAIRS FOR TRANSPOSITION OF THE GREAT ARTERIES: EARLY AND MIDTERM SURVIVAL AND FUNCTIONAL RESULTS
Authors: Aseervatham R. , Pohlner P. 
Published: January 2008

Background: The early experience in correction of simple transposition of the great arteries (TGA) involved redirection of atrial inflow to re‐establish systemic and pulmonary blood flow, the basis of the Senning and Mustard operations. Since 1984, however, the arterial switch operation (Jatene) has been increasingly used. It appears that with experience the peri‐operative mortality rate for arterial repair is comparable to that for atrial repairs, while the late morbidity rates have generally favoured arterial repair, with sequelae such as obstruction of venous inflow, dysrhythmias, systemic atrioventricular valve dysfunction and impaired systemic ventricle function being more common following atrial repairs. Methods: A retrospective review of patients surgically treated for TGA at the Prince Charles Hospital. Results: Between April 1973 and July 1994, 103 patients with simple TGA underwent surgical correction using one of three standard approaches currently advocated (arterial switch/Jatene, Senning or Mustard operations). Fifty‐one Jatene, 31 Senning and 21 Mustard operations were performed. Associated procedures included closure of ventricular septal defect, right and left ventricular outflow tract resection and pulmonary artery band removal. The coronary artery anatomy was found to be suitable in all except two patients when the Jatene operation was planned; both these patients had a Senning procedure without mortality. There were nine perioperative deaths (4 Jatene, 2 Senning, 3 Mustard), and five late deaths (1 Jatene, 1 Senning, 3 Mustard). Follow‐up was maintained to a mean time of 60.5 months (range, 9 days to 203 months). In the Jatene group there were five anastomotic stenoses (all involving the neo‐pulmonary artery), three cases of arryhthmias (two postoperative supraventricular tachycardia and one nodal rhythm) and two pulmonary valve stenoses. In the Senning group there were four anastomotic stenoses (three involving pulmonary vein and one causing superior vena cava (SVC) inlet obstruction) and four cases of arryhthmias (with one requiring permanent pacemaker insertion). In the Mustard group there were two cases of SVC obstruction and two permanent pacemaker insertions for bradycardia. Conclusions: These early and midterm results suggest that the arterial switch operation has comparable overall mortality to, and less morbidity than, the atrial repairs for TGA with the retention of left ventricle to systemic arterial connection, which may provide improved long‐term results.
A SYNOPSIS OF RADIATION ONCOLOGY IN AUSTRALIA, WITH PARTICULAR REFERENCE TO NEW SOUTH WALES
Authors: Morgan Graeme W. 
Published: January 2008

The specialty of radiation oncology had its beginning in Australia in 1896 following the discovery of X‐rays by Roentgen. The new technology was eagerly embraced and the use of X‐rays and radium for the treatment of cancer, even in the early 1900s, produced results which, although far from satisfactory by today's standards, resulted in cure and palliation of more superficial tumours. In the era immediately prior to World War II the speciality was regarded as having only a limited role to play in cancer management. The introduction of cobalt‐60 units and linear accelerators in the 1950s allowed for treatment of deep‐seated tumours without the skin, bone and other complications of orthovoltage machines (deep X‐rays). But the introduction of radiotherapy treatment into cancer care was blocked by other specialties anxious to preserve their own ‘turf and by medical administrators who believed the counter‐claims that either cancer was incurable or ‘the cure for cancer was just around the corner’ and it was therefore foolish to waste money on an expensive technology that had a limited future.With further developments in technology, modern radiotherapy is now a highly sophisticated treatment using sharply focused and deeply penetrating X‐rays and electron beams. Specialized treatments, such as automated afterloading brachytherapy, total body irradiation, stereotactic radiosurgery and computerized 3‐D planning to improve dose distribution, are now widely available. The outcomes of cancer patients with radiotherapy have also improved considerably and organ preservation (e.g. in breast and larynx cancer) has resulted in improved quality of life. However, the specialty has only recently begun to expand in specialist numbers and profile. This is partly due to the lack of undergraduate training in cancer in general and radiotherapy in particular and also because under‐staffing has meant that radiation oncologists have occupied a purely service role (in the basement with their machines) rather than being an active part of the treatment ‘team’. As a consequence radiation oncology has not been projected as an important component in cancer management and as a challenging and fulfilling career option to medical students and new graduates.The failure to act on the (repeated) recommendations of the 42 reports, inquiries, etc. into radiation oncology in Australia since 1982 (in addition to many more at local level) would suggest that the ‘message’ has yet to be accepted by Health Departments and health administrators. As a result there has been a totally uncoordinated approach to provision of radiation oncology services. The restriction of services and specialist numbers and training posts has led to radiotherapy being underutilized and undervalued in the treatment of cancer, ultimately to the detriment of cancer patients.
CRANIOFACIAL RESECTION OF ANTERIOR SKULL BASE TUMOURS: FACTORS CONTRIBUTING TO SUCCESS
Authors: Rutter Michael J. , Furneaux Christopher E. , Morton Randall P. 
Published: January 2008

Background:A case series of 20 consecutive patients followed for a minimum of 54 months following craniofacial resection of anterior skull base tumours is presented, with the aim of identifying complications and factors influencing survival.Methods:A retrospective review of a case series of 20 consecutive patients was carried out.Results:Dural invasion was significantly correlated with poorer survival. There was also a tendency for tumour grade and positive resection margins to be associated with poorer outcome. Most local recurrences occurred within 6 months of surgery, with the exception of adenocarcinoma of the ethmoids, in which recurrence occurred up to 36 months postoperatively. A variety of complications were encountered, with a marked decrease in serious complications from midway through the series.Conclusions:The change in pattern of complications may be indicative of a learning curve, or the discontinuation of the use of lumbar drainage.