bluuebunny/crossref_metadata_2025_split huggingface dataset:
CONCOMITANT CORONARY REVASCULARIZATION AND RESECTION OF LUNG CANCER
Authors: Rosalion A. , Woodford N. W. , Clarke C. P. , Buxton B. 
Published: January 2008

As age and smoking are common risk factors, patients with lung cancer frequently have coexistent ischaemic heart disease. Ignoring the coronary disease results in an unacceptable operative mortality, whilst sequential coronary grafting and lung resection may prejudice the results of the resection.A series of 10 patients underwent combined coronary revascularization (average 2.9 grafts per patient) and lung resection for carcinoma (seven lobectomies, one bilobectomy, one sleeve lobectomy, and one pneumonectomy). The majority of patients had unstable angina, triple vessel or left main coronary artery stenosis and poorly staged tumours. There was no operative mortality and the average hospital stay was 20 days. Half the patients had significant peri‐operative morbidity; seven are alive and well at between 12 and 38 months follow‐up; but three have died of recurrent carcinoma (one with associated sepsis) at 3,8, and 13 months.Combined coronary revascularization and lung resection can be safely performed in selected patients. The early morbidity is mainly related to the cardiac procedure and impaired respiratory function preoperatively, but the long‐term results are dependent upon the control of the lung carcinoma.
MALIGNANT FIBROUS HISTIOCYTOMA OF BONE: THE EXPERIENCE OF THE NEW SOUTH WALES BONE TUMOUR REGISTRY
Authors: Little David G. , McCarthy Stanley W. 
Published: January 2008

The New South Wales Bone Tumour Registry records for malignant fibrous histiocytoma were reviewed. Thirty‐eight cases were available for analysis, representing 8% of the 506 malignant bone tumours reported to the Registry over 15 years (1977–91). The review confirmed that malignant fibrous histiocytoma is a high‐grade primary bone sarcoma occurring in a wide age range in a bimodal distribution. Tumours mainly occurred around the knee or the ends of other long bones. Twenty‐six per cent of cases arose in a pre‐existing lesion, 4 cases post‐radiotherapy, 3 cases in Paget's disease, 2 cases in bone infarcts and 1 case each in osteoblastoma, osteosarcoma and giant cell tumour. Thirty‐two patients were treated by amputation or wide excision and in 11 patients this was preceded by intralesional curettage. Three patients had marginal resections and three had no surgery.Five year survival was 53% overall. Age at presentation significantly affected survival; patients under 55 years had a 5 year survival rate of 70%, compared with 19% for patients over 55 (P < 0.05). Survival was 86% at 5 years if the initial procedure was radical or wide, but only 30% if marginal or intralesional (P < 0.01). Adjuvant chemotherapy as an isolated factor did not affect survival. Rigorous adherence to the principles of surgical staging and biopsy was found to be the most successful way to treat malignant fibrous histiocytoma of bone.
RESULTS OF A POLICY OF SELECTIVE IMMEDIATE FISTULOTOMY FOR PRIMARY ANAL ABSCESS
Authors: Seow‐Choen F. , Leong A. F. P. K. , Goh H. S. 
Published: January 2008

A prospective study of a policy of selective immediate fistulotomy in the management of acute primary anal abscesses was performed. Eighty‐nine patients (74%) underwent simple drainage only, as no internal openings were found during drainage of pus (group A). Thirty‐one patients (26%) had drainage of pus and immediate fistulotomy (group B). Follow up for groups A and B occurred at a median of 122 weeks (104–136 weeks) and 121 weeks (104–136 weeks), respectively. No patient in group A had residual problems with anal continence whilst two patients (6.5%) from group B had minor anal incontinence following the initial procedure (p= 0.07). Ten patients from group A (11%) and four patients from group B (13%) developed recurrent anal sepsis. The overall rate of recurrent sepsis was 11.7%.In those patients who had incision and drainage alone, 90% of those who developed a recurrence and 71% of those who did not develop a recurrence grew gut‐associated organisms from pus obtained during the initial drainage of the acute abscess, giving a positive predictive value for recurrence of 13.8% for a culture of gut‐associated organisms. The positive predictive value for recurrent sepsis for both groups taken together for a culture of gut‐associated organisms was 28.2%.Patients with acute primary anal abscess should be treated with simple drainage.
CARBON DIOXIDE, TEMPERATURE AND LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Monagle J. , Bradfield S. , Nottle P. 
Published: January 2008

Laparoscopic procedures have previously been shown to interfere little with respiratory homeostasis. This study was designed to determine whether respiratory homeostasis, as well as temperature, is maintained with longer laparoscopic procedures and cold carbon dioxide insufflation.This study examined 21 American Society of Anesthesiologists status I and II patients undergoing laparoscopic cholecystectomy. A constant minute ventilation (80mL/kg per min) was instituted prior to peritoneal insufflation and end‐tidal carbon dioxide measurements were followed throughout the procedure. Although they showed a small statistically significant increase (32.3 ± 3.8 to 38.9 ± 6.0 mmHg, P= 0.0001) they were not of clinical significance. Similarly, rectal temperature measurements showed a statistically. but not clinically, significant fall in temperature over the course of the procedures (36.4 ± 0.46 to 36.2 ± 0.35°C, P = 0.0001). The changes in end‐tidal carbon dioxide and temperature showed no correlation with the volume of carbon dioxide used.The above findings will, however, require further investigation in both longer procedures and patients with more significant disease.
CAMPYLOBACTER JEJUNI ENTEROCOLITIS CAUSING PERITONITIS, ILEITIS AND INTESTINAL OBSTRUCTION
Authors: Perkins D. J. , Newstead G. L. 
Published: January 2008

Patients with Campylobacter enterocolitis may come to laparotomy due to the severity of abdominal symptoms and signs, although only two patients with intestinal inflammation have been described and in neither was the histopathology documented.A case of a 52 year old male who had a typical diarrhoeal illness of Campylobacter enterocolitis diagnosed on stool culture is reported. Despite appropriate treatment he developed signs and symptoms consistent with small intestinal obstruction. Laparotomy revealed peritonitis and thickened distal ileum with transmural inflammatory changes on histopathology. These changes were shown to have completely resolved at a second laparotomy, required for persistent obstruction due to adhesions. Recurrent adhesions culminated in a third laparotomy.The clinical, operative and histopathological findings may be confused with Crohn's disease.
EARLY EXPERIENCE WITH MINIMALLY INVASIVE SURGERY: A NEW ZEALAND AUDIT
Authors: Windsor John A. , Vokes David E. 
Published: January 2008

The clinical and economic impact of minimally invasive surgery in New Zealand, especially laparoscopic cholecystectomy, has been profound but uncharted. A postal questionnaire was sent to all general surgeons in New Zealand (n= 214), in order to document the current levels of experience, adequacy of training, levels of equipment and sources of funding. In the case of laparoscopic cholecystectomy, further details were obtained relating to operative technique, complication rates and approaches to the management of choledocholithiasis.The response rate was 71%. From 27 centres, 71 of 106 active general surgeons were performing minimally invasive surgery. Of the 34 different procedures audited, cholecystectomy (3056), hemiorraphy (178), and appendicectomy (141) were performed most often. Primary funding came from Area Health Boards (71%) and private hospital funds (25%) with 4% coming from other sources. Ten different camera/insufflator systems were used. Training was perceived to be adequate by the majority of surgeons (89%), although seven surgeons had received no specific training. Laparoscopic cholecystectomy technique included: prophylactic antibiotics (89% of surgeons), patients supine (80%), wound infiltration (80%), routine use of diathermy within triangle of Calot (36%) and a routine peritoneal drain (13%). Routine operative cholangiography was used rarely (7%) and 72% of surgeons had deliberately changed their policy with respect to its use. Twenty‐two cases of laparoscopic biliary injury were identified by the survey, none of whom had operative cholangiography. The conversion rate was 13% for acute and 4% for elective laparoscopic cholecystectomy. This survey indicated the broad scope of minimally invasive surgery that is being undertaken, and highlights potentially important variations in surgical practice.
THE DEVELOPMENT AND ENHANCEMENT OF THE COLLATERAL CIRCULATION IN AN ANIMAL MODEL OF LOWER LIMB ISCHAEMIA
Authors: Chleboun J. O. , Martins R. N. 
Published: January 2008

In an animal model of hind limb ischaemia we documented the levels of endogenous basic fibroblast growth factor (bFGF) in control and ischaemic hind limbs, and evaluated the response to the administration of exogenous recombinant bFGF and heparin, Variations in this model were tested for their ability to alter the development of the collateral circulation. Recovery after acute arterial occlusion was significantly delayed by immediate bilateral mirror‐image arterial ligations, when compared with either unilateral arterial ligation or delayed contralateral ligations performed after 2 months. If the major veins were also occluded all limbs developed gangrene, tissue loss and a marked delay in the recovery of blood flow, while none of the animals with unilateral arterial ligations developed gangrene. This indicates that the recovery in blood flow during the acute phase in this model is dependent on collateral vessels from the contralateral iliac artery and that major venous occlusion impedes the development of collateral vessels. Lumbar sympathectomy did not alter the recovery of blood flow after arterial occlusion, suggesting that collateral blood flow is not significantly influenced by autonomic neural supply.Following arterial occlusion there was a ten‐fold increase in the levels of endogenous bFGF in all ischaemic muscle groups. Intramuscular implantation of bFGF in heparin‐sepharose pellets at the time of arterial ligation markedly enhanced the blood flow for 3 weeks compared with untreated ischaemic limbs. A further increment in blood flow occurred if an additional dose of bFGF was administered 4 weeks after ligation. Administration of heparin for 1 week during either the acute or chronic phases of collateral development significantly improved the blood flow in ischaemic limbs. This was neither as profound nor as prolonged as that observed for bFGF. Treatment with heparin for 4 weeks following arterial ligation provide an increased blood flow for the first 3 weeks. These results indicate that tissues respond to ischaemia by an increased release of bFGF and that the evolution of collateral vessels can be enhanced by the administration of both exogenous recombinant bFGF and heparin. We conclude that bFGF is an important biochemical mediator in the development of the collateral circulation.
HEPARIN THROMBOPROPHYLAXIS VIA INDWELLING SUBCUTANEOUS TEFLON CANNULA
Authors: Pouw Louis , Kilsby Dianne , Francis Paul , Tulloh Bruce 
Published: January 2008

The aim of this study was to evaluate the administration of postoperative heparin thromboprophylaxis via an indwelling subcutaneous cannula. Fifty consecutive patients undergoing laparotomy, laparoscopy or varicose vein surgery were studied. Each patient on admission had a 24 gauge subcutaneous cannula inserted and a conventional subcutaneous heparin injection preoperatively. The first 20 patients received an alternating postoperative regimen of morning heparin via cannula and evening heparin via conventional injection into the abdominal wall. The remaining 30 patients received postoperative heparin twice daily via the cannula. Patients and nursing staff were interviewed and their preference for either method was recorded.There were no significant complications with the cannula system. Although it was more costly and nursing staff found it more labour intensive than conventional subcutaneous injections, the majority of patients preferred to receive heparin via the cannula. We conclude that this is an excellent method of administering prophylactic subcutaneous heparin, especially for patients with a strong aversion to injections.
THE COSTS OF TREATING BREAST CANCER IN AUSTRALIA AND THE IMPLICATIONS FOR BREAST CANCER SCREENING
Authors: Butler J. R. G. , Furnival C. M. , Hart R. F. G. 
Published: January 2008

The aim of the study was to determine if there is a relationship between the stage of breast cancer at the time of detection and the costs of treatment and to assess whether any such relationship would have an influence on the cost of a mammographic screening programme.A retrospective analysis of the stage at presentation for primary breast cancer and the treatment costs over the duration of treatment was made. Multiple regression analysis was employed, with treatment cost as the dependent variable and categorical variables to represent stage at detection. A total of 301 women whose treatment for breast cancer commenced at the Royal Brisbane Hospital participated in the study.A statistically signficiant relationship was found between the stage of disease at the time of detection and subsequent treatment costs; more advanced stages of disease incurred higher treatment costs. This relationship was robust even after taking into account the age of patients, their discharge status, and differences between patients in the duration of treatment. When the effect of earlier detection on treatment cost was assessed in relation to a breast screening programme, cost savings were estimated to be in the range of 8–36% of total screening costs.There are treatment cost savings to be gained from breast cancer screening as a result of the detection of earlier stages of disease. These treatment cost savings should be offset against the cost of a mammographic screening programme.
ANAL PATHOLOGY IN PATIENTS WITH CROHN'S DISEASE
Authors: Platell Cameron , Mackay John , Collopy Brian , Fink Roy , Ryan Peter , Woods Rodney 
Published: January 2008

Background: A distinctive feature of patients suffering from Crohn's disease is a predisposition to develop a variety of anal complications. The aetiology of such conditions is unclear, and the reported incidence of anal involvement in Crohn's disease varies party due to the various criteria used for classification. This study aims to review the management of patients with symptomatic anal pathology associated with Crohn's disease at St Vincent's Hospital, Melbourne. Methods: A database of 306 patients with Crohn's disease referred to the department between January 1978 and October 1994 was reviewed to identify those patients with symptomatic anal disease. The anal pathology was recorded and classified. Demographic data and the clinical and surgical history of the patient were recorded. Results: Of the 306 patients with Crohn's disease, 129 (42.4%) were identified as having symptomatic anal pathology. Patients were likely to present with anal symptoms after they had been diagnosed as having intestinal Crohn's disease (46.1%). The commonest presentations were perianal abscess (29.5%), anal fissure (27.6%), and low anal fistula (26.7%). A minority of patients presented with highkomplex anal fistulae (3.8%), or recto‐vaginal fistulae (5.2%). Five per cent of patients had Crohn's disease localized to the anal area. The pattern of intestinal disease in the remaining patients was small bowel 21.1%. small bowel and colon 31.9%, and colon 43.0%. A total of 244 local anal surgical procedures were performed on these patients; the commonest of these were drainage of an abscess (38.5%), examination under anaesthetic (29.1%). and laying open of a low anal fistula (22.5%). Following surgical treatment, the recurrence rate for perianal abscesses was 13%, and for low anal fistulae 6%. Conclusions: The majority of patients with Crohn's disease who develop anal pathology have an excellent prognosis. A minority of patients develop complex anal fistulae and these remain a therapeutic challenge.
THE RISK OF AN UNPLANNED RETURN TO THE OPERATING ROOM IN AUSTRALIAN HOSPITALS
Authors: Ansari Mohammad Z. , Collopy Brian T. 
Published: January 2008

Background: The unplanned return of the patient to the operating room (OR) after a previous procedure has implications concerning the quality of surgery, but little has been written on this subject.Methods: The relationship of bed‐size and hospital type (private or public) was studied using data on this clinical indicator submitted to the Australian Council on Healthcare Standards Care Evaluation Program (ACHS CEP) by hospitals presenting voluntarily for accreditation in 1993.Results: The mean rate of an unplanned return to OR was 0.6% (95% confidence interval 0.5–0.7). After adjusting for potential confounders in a logistic model, the risk of unplanned return to OR did not significantly differ by type of hospital (private, public), and location (rural, metropolitan). The risk of an unplanned return to OR was higher in large compared with small hospitals.Conclusions: The finding of the risk of the event being greater in large compared with small hospitals is likely to be a reflection of casemix. An internal review of results (for any facility) is obviously necessary. With some operations a higher incidence of return to the OR may indicate vigilance in peri‐operative management.
OPERATIVE CHOLANGIOGRAPHY IN THE LAPAROSCOPIC ERA: A RETROSPECTIVE REVIEW OF THE QUALITY AND INTERPRETATION OF THIS INVESTIGATION
Authors: Draganic Brian , Perry Richard , Gani Jon 
Published: January 2008

Background: Operative cholangiograms during the year of introduction of laparoscopic cholecystectomy were reviewed to examine their quality and interpretation.Methods: 149 operative cholangiogram films (34 open and 115 laparoscopic) were reviewed retrospectively by a panel and scored for their ability to demonstrate biliary anatomy and detect bile duct stones.Results: Cholangiography performed by the cystic duct was of similar quality, whether performed laparoscopically or open. Cholangiography via the cystic duct (conventional films) produces superior results for both anatomical delineation and detection of choledocholithiasis (80% adequate) than cholangiography performed by direct gallbladder puncture (29–35% adequate).Conclusion: There is no clear evidence to suggest that an intra‐operative specialist radiological review of cholangiograms performed by the cystic duct would improve the detection of bile duct stones.
NODULAR FASCIITIS AND RELATED PSEUDOSARCOMATOUS LESIONS OF SOFT TISSUES
Authors: Samaratunga H. , Searle J. , O'Loughlin B. 
Published: January 2008

Background: Nodular fasciitis is characterized by a proliferation of spindle cells which may be misdiagnosed as sarcomas due to the rich cellularity, mitotic activity and variant morphologic patterns.Methods: This report includes 42 cases of nodular fasciitis and related conditions of skin and soft tissue from the pathology files of the Royal Brisbane Hospital, Queensland, Australia. There were 33 cases of nodular fasciitis, three cases of ossifying fasciitis, three cases of proliferative fasciitis, two cases of proliferative myositis and one case of intravascular fasciitis. Two‐thirds of cases were referred from outside Royal Brisbane Hospital.Results: Nodular fasciitis and ossifying fasciitis occurred most commonly in young adults with 16 patients (44%) between the ages of 20 and 29. However, the other variants of nodular fasciitis including proliferative fasciitis, proliferative myositis and intravascular fasciitis occurred in older people (six patients being older than 49 years) and more commonly occurring in men (n= 5). A painless, rapidly growing mass was most common. The lesions of nodular fasciitis were most often located in the upper extremity with the forearm most commonly affected.Conclusions: Nodular fasciitis and related conditions are benign. All patients are alive and well 3 months to 13 years (mean 7.2 years) after simple local resection.
IS THE MID‐INGUINAL POINT AN ACCURATE LANDMARK FOR THE COMMON FEMORAL ARTERY IN VASCULAR PATIENTS?
Authors: Hunt Jeremy A. , Harris John P. 
Published: January 2008

Background: An accurate guide to the common femoral artery (CFA) is important in vascular patients as the CFA pulse may not be palpable. At least four different descriptions of the surface anatomy of the CFA are given in standard anatomic texts. This study was undertaken to determine the accuracy of the mid‐inguinal point as a guide to the CFA in patients undergoing femoral arteriography.Methods: The surface anatomy of the CFA was determined using true anteroposterior arteriograms of 30 patients [20 men, 10 women, age (mean ± s. d.) 67 ± 6.8 years, range 56–82].Results: The distance between the anterior superior iliac spine (ASIS) and the symphysis pubis was measured with callipers and defined as the inguinal distance [(mean ± s. d.) 16.03 ± 1.06 cm, range 14.00–18.50]. The midpoint of this line defined the mid‐inguinal point. Similarly, the distance was measured from the symphysis pubis to the midpoint of the CFA where it crossed the inguinal line on the arteriogram, and was defined as the femoral distance [(mean ± s.d.) 7.99 ± 0.51 cm, range 6.80–9.00]. The location of the CFA coincided with the mid‐inguinal point in only six (10%) of the 60 measurements. The difference between the CFA and mid‐inguinal point varied from 1.25 to 1.50 cm either side of the mid‐inguinal point, and in six (10%), the difference was 1 cm or more, and therefore of clinical significance.Conclusions: On the basis of these findings we conclude that the relationship between the mid‐inguinal point and the CFA is not exact in vascular patients undergoing arteriography. The mid‐inguinal point, found using bony landmarks, is an appropriate guide to the CFA as it can be expected to lie within 1.5 cm either side of the mid‐inguinal point. The natural variability observed could account for the different anatomical descriptions of the surface anatomy of the CFA. No exact definition may be possible.
RE‐OPERATION FOR FAILED ANTI‐REFLUX SURGERY
Authors: Lim J. K. , Moisidis E. , Munro W. S. , Falk G. L. 
Published: January 2008

Background: Between 1993 and 1995, 315 anti‐reflux procedures were undertaken on our service. A previous antireflux procedure had been performed in 31 patients referred (10%). Previous surgery was, in the main (80%), a Nissen fundoplication.Methods: Re‐operative investigations in all patients were manometry, 24 h pH monitoring, oesophagoscopy and barium radiology. On this basis the causes of failure of the previous surgery were established as hiatal failure in 20 (65%), unrecognized oesophageal dysmotility in three (10%) and fundoplication failure (slipped and disrupted) in eight (25%). Contrary to standard recommendations for re‐operation most re‐operative surgery was performed transabdominally (94%). Complications occurred in 16%.Results: Review was undertaken at a mean of 21 months following surgery, and 91% of patients reported a good to excellent symptomatic outcome.Conclusions: Transabdominal re‐operative anti‐reflux surgery has an acceptable complication rate and a surprisingly good symptomatic outcome in the medium term.