bluuebunny/crossref_metadata_2025_split huggingface dataset:
REVIEW OF PYOGENIC LIVER ABSCESS AT THE ROYAL ADELAIDE HOSPITAL 1980‐1987
Authors: Karatassas A. , Williams J. A. R. 
Published: January 2008

Pyogenic liver abscess is an uncommon condition which carries substantial morbidity and mortality if untreated. A review was undertaken of 31 patients who were admitted to the Royal Adelaide Hospital (RAH) between January 1980 and December 1987 and who were diagnosed as having pyogenic liver abscess. The aims of the study were to review the aetiology, current methods of investigation and treatment of the disease, and to formulate a management plan based on the findings.Hypoalbuminaemia, leukocytosis and elevated alkaline phosphatase were the most common findings. Hyperbilirubinaemia was not a usual feature. Computerised tomography (CT) scanning and ultrasound were the most useful imaging modalities in identification of the abscess. The sensitivity of CT scanning in evaluating the size of abscesses was lower than anticipated and this may lead to a higher than necessary rate of surgical drainage. A case is presented to illustrate this.Most abscesses were secondary and frequently due to extension of infection from biliary structures. Diseases causing diminished resistance to bacterial infection had a significant role in the pathogenesis.The overall mortality rate was 25%. Risk factors increasing mortality included advanced age, multiplicity of abscesses, depressed immune status and the presence of complications due to the abscess. Of patients who survived, four were treated with antibiotics alone. eleven with percutaneous drainage and antibiotics, and eight with surgery and antibiotics.We conclude that patients with hepatic abscesses should be managed initially by CT or ultrasound‐guided aspiration. If pus is obtained a percutaneous drain should be inserted into the cavity and systemic antibiotics administered. If serosanguineous fluid only is obtained this may indicate oedema around a small abscess (or inflammatory focus) and may be treated with systemic antibiotics only. Surgical drainage should be reserved for cases in which improvement does not occur with aspiration or percutaneous drainage and appropriate systemic antibiotics.
PANCREATITIS AND PANCREAS DIVISUM: AETIOLOGICAL AND SURGICAL CONSIDERATIONS
Authors: Brenner P. , Duncombe V. , Ham J. M. 
Published: January 2008

It has been suggested that acute pancreatitis occurs more commonly in patients with pancreas divisum and that these patients may respond to surgery aimed at improving pancreatic ductal drainage. We have studied them incidence of pancreas divisum in patients referred for endoscopic retrograde cholangio pancreatography (ERCP) and the results of surgical sphincteroplasty in a separate series of such patients.Twenty‐three patients with pancreas divisum were identified among 336 successful pancreatograms (Group A), an incidence of 6.8%. The incidence of pancreas divisum in patients having ERCP for documented pancreatitis was 13% (11 of 86) compared with 4.8% (12 of 250) in those having ERCP for other indications. This difference was statistically significant (P < 0.05). However, pancreas divisum was not the sole risk factor for pancreatitis in the majority of our patients; most also had one of the commonly recognized causes for their pancreatitis.There is dispute about the indications for surgery in patients with recurrent acute pancreatitis and pancreas divisum, but without any other risk factor. We have reviewed the results of operations on 13 patients with pancreas divisum (Group B) treated in four different hospitals.Surgical sphincteroplasty was carried out on 10 patients with documented pancreatitis and seven of these had good results. Three patients who had operations for pain without documented pancreatitis were not improved.
DETECTION OF ARTICULAR DEFECTS USING MAGNETIC RESONANCE IMAGING: AN EXPERIMENTAL STUDY
Authors: Mah E. T. , Langlois S. Le P. , Lott C. W. , Lee W. K. C. , Brown G. 
Published: January 2008

This study evaluates magnetic resonance imaging (MRI) in the detection of surgically created articular defects in bovine knees. A total of 26 articular defects was created in 2 fresh cadaveric cows’knees. The defects created include chondromalacic grade 2 defects, chondral and osteochondral defects from 3 to 15 mm in diameter. The knee joints were repaired in a normal saline bath to exclude air in the joint prior to MR scanning.T1 weighted spin echo (SE) images and 3D gradient echo (FISP 40° 3D) images were obtained. The T1 weighted SE imaging technique detected 15 defects (57.7%) compared with FISP 3D imaging technique detection of 17 defects (65.4%). The two techniques combined enable 21 of 26 defects (80.8%) to be detected. The imaging techniques used in this study were not able to detect chondromalacic defects less than 10 mm in diameter, nor chondral defects less than 5 mm in diameter. However, small osteochondral defects of 3 mm in diameter are detectable provided the depth of the defect is not less than 10 mm.The FISP 3D imaging technique alone is more sensitive in detecting chondral defects. Both imaging techniques have similarly high sensitivities in detecting osteochondral defects.The imaging time for combined T1 weighted SE and FISP 3D sequence is short (16.5 min) and this combined technique may be useful for MR scanning of knee joints suspected to have articular defects.
A SURVEY OF ANTIMICROBIAL PROPHYLAXIS IN ELECTIVE COLORECTAL SURGERY IN NEW ZEALAND
Authors: Mercer P. M. , Bagshaw P. F. , Utley R. J. 
Published: January 2008

In 1988 a survey of New Zealand general surgeons was conducted, by post, on the subject of routine antimicrobial prophylaxis for elective colorectal surgery. Surgeons who gave routine prophylaxis were asked for details of their regimens; those who did not were asked for their reasons.One hundred and seventy‐five questionnaires were distributed and 167 were returned. Of these, 124 came from surgeons with a colorectal practice, and 118 of the 124 surgeons satisfactorily completed the questionnaire. Routine antimicrobial prophylaxis was given by 96.6% (114 of 118).Of the 114 surgeons prescribing prophylaxis, one antimicrobial agent was used by 36.8%, two were employed by 53.5% and three or five were used by the remainder. The most commonly used (74.6%) antimicrobial agents were cephalosporins which were prescribed, alone or in combination with a nitroimidazole. The most frequent duration (46.4%) of antimicrobial administration was a combination of both the peri‐ and postoperative periods.When antimicrobial spectrum, route and duration of administration were all taken into account, 49.1 % (56 of 114) were considered to give satisfactory regimens. Excessively protracted administration was the most frequent reason for unsatisfactory classification.The results of this survey demonstrate serious deficiencies in the practice of antimicrobial prophylaxis in elective colorectal surgery. These should be addressed through a programme of continuing education.
GENERAL SURGICAL MANPOWER, VICTORIA, AUSTRALIA*
Authors: Nelson P. G. 
Published: January 2008

To provide information for the planning of general surgical manpower in Victoria for the next 2 decades, an attempt was made to establish a statewide profile of surgical practices and an analysis of surgical activity to determine whether surgeons' and the community's needs were being met.Of 343 practising general surgeons, 280 furnished returns to a questionnaire—a return rate of 81.6%. Responses to the questionnaire reveal that the current surgeon‐to‐population ratio is optimal, although certain imbalances and concerns exist. Surgeons are fully occupied regardless of age, location of practice or type of practice, and they work long hours. Most surgeons regard themselves as not overworked and most are satisfied, although not all do the type of work they would prefer. Current surgical training programmes, however, appear inadequate for future needs.
COMPARISON OF THE PERFORMANCE OF VISUAL AND VERBAL MULTIPLE‐CHOICE QUESTIONS
Authors: Buzzard Anthony J. , Bandaranayake Raja C. 
Published: January 2008

A study was carried out to determine whether multiple‐choice questions based on visual trigger material, such as micrographs, photographs or radiographs, were more difficult and more discriminating than corresponding verbal questions testing: (i) the same information; (ii) different information in the same content area. Seventy‐seven question triplets, each of which contained a visual (X) question, a verbal (Y) question testing the same information and a verbal (Z) question testing different information in the same content area were set in twelve Part 1 FRACS examinations. The questions were arranged in such a way that the X and Z questions in a triplet were set in the same examination, while the Y question was set in the corresponding examination of the previous or the following year. The specific outcomes studied were those on facility index and r biserial discriminating index.An analysis of variance on the data pertaining to each index did not indicate significant differences among the groups. None of the differences between pairs of mean facility indices among question groups X, Y and Z was found to be significant at P < 0.05, nor were any of the differences between pairs of r biserial discriminating indices found to be significant at P < 0.05.It was concluded that visual questions set in the Part I FRACS examination were not demonstrably more difficult or more discriminating than the corresponding verbal questions. The findings do not detract, however, from the obvious importance of visual recognition for future surgeons.
WOUND INFILTRATION WITH 0.25% BUPIVACAINE NOT EFFECTIVE FOR POSTOPERATIVE ANALGESIA AFTER CHOLECYSTECTOMY
Authors: Adams Warwick J. , Avramovic John , Barraclough Bruce H. 
Published: January 2008

The instillation of local anaesthetic agents into surgical wounds has been reported to be an effective method of reducing pain and narcotic requirements, using both local injection1,2 and topical application3 techniques. We performed a double‐blind trial to test the value of the long‐acting local anaesthetic, bupivacaine, in this role.Eighty patients undergoing elective cholecystectomy were entered into the study. They were divided into 2 groups of 40 patients to compare a local injection technique with a topical application technique. For each route of application. 20 patients received a test solution containing 0.25% plain bupivacaine, and 20 received 0.9% NaCl as a control. Postoperative analgesia in the form of intramuscular pethidine (1–1.5mg/kg) was made available to all patients on request.The degree of postoperative pain was assessed using three criteria: the time from operation to the first request for analgesia, the total dose of postoperative pethidine required during the first 3 postoperative days and the patient's rating of pain on a 10cm linear analogue scale at 24h and 72 h.There was no statistically significant difference between the degree of postoperative pain experienced by patients receiving bupivacaine and those receiving NaCl, when assessed by any criterion. There was also no significant difference found between patients receiving bupivacaine by local infiltration and those receiving the drug topically. It is concluded that the local application of bupivacaine to the wound is not an effective analgesic technique following laparotomy for cholecystectomy.
POROUS COATED ANATOMIC NON‐CEMENTED TOTAL HIP ARTHROPLASTY
Authors: Holman P. R. , Tyer H. D. D. 
Published: January 2008

Between November 1984 and December 1989, 318 non‐cemented Porous Coated Anatomic (PCA; How‐medica, Rutherford, New Jersey) total hip replacements were performed by the authors. A follow‐up of 1 to 6 years was allowed. The average age was 53.1 years (from 17 to 71 years). The distribution of right‐to‐left was approximately equal.There were 192 hip replacements for primary and post‐traumatic osteo‐arthritis, 42 for rheumatoid arthritis, 40 for avascular necrosis, 29 for congenital dislocation or hip dysplasia with secondary osteo‐arthritis, 6 for Perthes disease, 5 for previous sepsis, 2 of whom had had a Girdlestone procedure, 2 for revision of a painful cup arthroplasty, and 1 for conversion of a previously fused hip.All patients were evaluated on a one hundred point Harrington Arthritis Research Centre Scale. Points were awarded for pain (0–35), function (0–35), motion (0–10), deformity (0–10) and gait (0–10). Pre‐operative total scores averaged 45.5 (9–71) and postoperative scores averaged 83.9 (55–98). The overall results were excellent 20.5% (90–100), good 59.8% (80–90), fair 16.4% (70–80), and poor 3.3%.Postoperative radiographs were evaluated using zonal analysis. There was no deterioration on the radiographs after two years.
A SURVEY OF INTERHOSPITAL TRANSFER OF HEAD‐INJURED PATIENTS WITH INADEQUATELY TREATED LIFE‐THREATENING EXTRACRANIAL INJURIES
Authors: Henderson A. , Coyne T. , Wall D. , Miller B. 
Published: January 2008

A 12 month prospective study was undertaken to determine the frequency of untreated life‐threatening extracranial injuries in patients transferred to a major trauma centre because of head injury. Of the 43 patients transferred (15 with isolated head injury and 28 with multiple injuries), four (9%) had an untreated life‐threatening extracranial injury, which caused death in two.All four patients with untreated extracranial injuries were transferred from hospitals with general surgical staff and facilities. In three of the patients (none with a major head injury), the extracranial injuries were recognized at the referring hospital, but were left untreated in the rush to transfer the patient to a neurosurgical facility. In the fourth patient, who had a severe head injury, recurrent hypotension from a ruptured spleen was mistakenly ascribed to a scalp wound.The series shows that the dangerous practice of hurriedly transferring patients to trauma centres because of actual or perceived head injuries, while leaving major extracranial injuries untreated, continues despite warnings in the literature and the efforts of the Royal Australasian College of Surgeons through the Early Management of Severe Trauma programme.
EXPERIMENTAL CALVARIAL GROWTH DISTURBANCE BY MICRO‐PLATE AND SCREW FIXATION
Authors: Courtemanche D. J. , Mutimer K. L. , Holmes A. D. , Levant B. A. , Clement J. G. 
Published: January 2008

A study was designed to help ascertain the effects of rigid internal fixation in the growing skull.Five piglets underwent plating of the left coronal suture at 3 weeks of age. At the time of surgery metal markers were placed to follow bone growth. Cephalometric radiographs, direct osteometry at sacrifice, gross pathological examination and specimen radiography revealed a localized disturbance of growth. There was a restriction of sutural displacement and appositional bone growth at the site of the plate. Local restriction of sutural growth was almost complete during the experimental period. There was an alteration to a ‘mature’ suture morphology, without synostosis, of the suture on the plated side not seen on the control side. A plagiocephalic pig was not produced nor was there an orbital deformity. A large local contour deformity developed and by the end of the experimental period the plate had become completely incorporated in bone.These effects were statistically significant as well as clinically significant. The clinical use of this type of fixation in reconstructive surgery of the infant craniofacial skeleton is questioned in light of the result.
THE MANAGEMENT OF RENAL CELL CARCINOMA WITH INFERIOR VENA‐CAVAL INVOLVEMENT
Authors: Burt James D. , Bowsher Winsor G. , Joyce Gerard , Peters Justin S. , Wood Alex , White Antoniette , Costello Anthony 
Published: January 2008

Seven patients with renal cell carcinoma involving the inferior vena cava underwent surgical resection between 1975 and 1991. Pre‐operative staging defined five patients with stage T3bNoMo disease, one patient with stage T3bN1Mo, and one patient with stage T3bNoM 1 disease.1 At operation one patient had tumour thrombus filling the right atrium. Two patients had tumour thrombus within the intrahepatic vena cava and four infrahepatic tumour thrombus. The mean follow‐up is 34.4 months (median 40 months). Four patients have been followed for over 4 years. Three of these patients are survivors, two have remained disease‐free since their initial surgery. The other patient had a liver resection at 49 months for a solitary metastases; he is currently disease free. One patient died at 38 months from a gastrointesinal haemorrhage. Three patients are 12 months or less postoperation. Operative mortality was zero. The mean postoperative hospital stay was 14.7 days.Data suggests that 3–10% of renal cell carcinomas will involve the inferior vena cava.2 The small number of patients in this series suggests that many patients with renal cell carcinoma involving the inferior vena cava are not referred for surgical assessment. These patients are potential surgical candidates. Their survival after surgical resection, excluding the group with extension of tumour thrombus into the hepatic cava or above, is not reduced when compared with other patients with renal carcinoma.3,4
PRIMARY CENTRAL NERVOUS SYSTEM TUMOURS IN AUSTRALIA: A PROFILE OF CLINICAL PRACTICE FROM THE AUSTRALIAN BRAIN TUMOUR REGISTER
Authors: Kaye Andrew H. , Giles Graham G. , Gonzales Michael 
Published: January 2008

An epidemiological survey of all primary central nervous system tumours in Australia was commenced in 1986. Cases were reported by the treating physician to the Australian Brain Tumour Register, located at the Victorian Cancer Registry. Ninety‐three per cent of tumours were histologically confirmed and 69% were reviewed by an independent pathology panel. During the initial 3 years of the survey a total of 4577 brain tumours and 266 primary spinal cord tumours were reported to the Register. The age standardized rates for malignant tumours of the central nervous system, sum to 5.0/100000 males and 3.4/100000 females.Twenty‐eight per cent of gliomas were biopsied only. Radiotherapy was administered to 57% of cerebral gliomas and 2% of these tumours were treated with adjuvant chemotherapy. Forty per cent of meningiomas were considered to have had a complete tumour resection.
BENNETT'S FRACTURE: A MEDIUM TO LONG‐TERM REVIEW
Authors: Thurston A. J. , Dempsey S. M. 
Published: January 2008

Seventy‐six patients who had sustained Bennett's fractures before 1985 comprised the patient base, Of these, 21 could be contacted and were reviewed at an average of 7 years 7 months after fracture to determine the effect of the quality of reduction on clinical and radiological outcome. Those cases that healed with up to 1 mm of fracture displacement were found to have superior results to cases where the reduction was less accurate. However even in those cases where a good reduction was not achieved the results were generally satisfactory with only one of 76 patients being known to have required a subsequent fusion of the first carpometacarpal joint. The subjective results in most patients had not deteriorated with time.It is recommended that a reduction with less than I mm displacement of the fracture be achieved in cases of Bennett's fracture. The particular technique by which the reduction is achieved and held is immaterial.
THORACOSCOPY: A USEFUL DIAGNOSTIC AND THERAPEUTIC PROCEDURE
Authors: Merriman T E. , Corbet J. D. 
Published: January 2008

This study was performed to review the place of thoracoscopy in the diagnosis and treatment of intrathoracic disorders. A combined retrospective and prospective review was undertaken of the first 50 patients who undenvent diagnostic or therapeutic thoracoscopy in Ballarat.Recurrent pleural effusions (29), pneumothoraces (7), or diffuse or localized lung disease (14) were the main indications. Thoracoscopy was performed in conjunction with pleural or lung biopsy, excision of cysts, or pleurodesis.Patient tolerance of the procedure was excellent with minimal postoperative pain. Operative morbidity rates were very low (< 4%). The low mortality rate was related to underlying disease processes. Hospital stay was short.The long‐term results were excellent. Adequate tissue was obtained on biopsy in most cases, cure achieved for pneumothoraces, and permanent palliation after talc pleurodesis for malignant effusions approached 80%.
SURGERY FOR SEVERE CONSTIPATION: THE USE OF RADIOISOTOPE TRANSIT SCAN AND BARIUM EVACUATION PROCTOGRAPHY IN PATIENT SELECTION
Authors: Mahendrarajah K. , Schaaf A. A. Van der , Lovegrove F. T. , Mendelson R. , Levitt M. D. 
Published: January 2008

Nineteen women aged 19–64 years (median 38) with intractable constipation were assessed by Indium‐111 DTPA colonic transit scan and barium evacuation proctogram. Patients were classified as having an isolated (I) or predominant disorder of colonic transit (II). a mixed disorder of colonic transit and rectal evacuation (III), a predominant disorder of rectal evacuation (IV) or normal colorectal emptying (V). Twelve patients fell into categories I and II and were considered suitable for surgery. Three responded to further vigorous aperient therapy and nine (32–55 years, median 38) underwent subtotal colectomy with ileorectal anastomosis at the level of the sacral promontory.Two patients required re‐operation for suspected anastomotic leak. One patient required readmission on two occasions for small bowel obstruction. Follow up has been 2–21 months (median 16). Eight of the nine patients no longer take oral aperients. Eight patients have a satisfactory stool frequency of 2–8 per 24 h; the other patient has an ileostomy and incapacitating postprandial abdominal pain. Abdominal pain is troublesome in two other patients. Two patients require antidiarrhoeal therapy but none experience faecal incontinence. In severely constipated patients with a proven disorder of colonic transit but normal or near normal rectal evacuation subtotal colectomy provides excellent symptomatic relief.
THE VALIDITY OF DOPPLER‐DERIVED SPECTRAL ANALYSIS IN THE PRESENCE OF MULTIPLE STENOSES
Authors: Latino J‐M. , Chleboun J. O. 
Published: January 2008

It has been suggested that mathematical analysis of ultrasonic Doppler spectral waveforms allows non‐invasive quantification of arterial stenoses proximal to the Doppler probe. Less emphasis has been placed on the influence of distal stenoses or distance to the ultrasonic probe. A benchtop electromechanical model with multiple stenoses was constructed to evaluate the effects on spectral waveforms of variations in the severity of proximal and distal stenosis, length of stenoses, distance between stenoses, and distance between ultrasonic probe and stenoses. The following analytic indices, descriptive of spectral waveforms, were evaluated: pulsatility index, spectral broadening index, Laplace damping factor, mode frequency, mean frequency, arithmetic mean frequency, maximum envelope frequency and minimum envelope frequency. All these indices, except the mode frequency, were influenced by the degree of distal as well as proximal stenosis. They were also affected by the distance between the Doppler probe and the upstream and downstream stenoses. The length of stenoses did not influence the flow waveform. Of the model variables, the distal stenosis had the greatest influence on the calculated indices. However, none of the analytic techniques could detect a stenosis smaller than a 70% reduction in cross‐sectional area.It was concluded that Doppler‐derived spectral waveforms between sequential stenoses are inevitably influenced by events other than the degree of proximal stenosis alone. Therefore, ultrasonic spectral waveforms obtained at a single point of the arterial tree in patients with multisegment arterial disease should be interpreted with caution.