bluuebunny/crossref_metadata_2025_split huggingface dataset:
RESEARCH NOTE: THE LIONS CANCER INSTITUTE AND THE WESTERN AUSTRALIAN SOCIETY OF PLASTIC SURGEONS SKIN CANCER SCREENING PROGRAMME
Authors: Katris Paul , Crock John G. , Gray Bruce N. 
Published: January 2008

Background: The Lions Cancer Institute, Perth, and the Western Australian Society of Plastic Surgeons have been investigating the feasibility of community based skin cancer screening. Members of the community responded to newspaper advertisements to attend free skin cancer screening events. This report presents preliminary results obtained from the methods development programme.Methods: Seventeen screening clinics were conducted in Perth (4) and country towns (14) in Western Australia between January 1991 and October 1993. The participants were interviewed and given promotional literature and their personal profiles were determined. A total body skin examination was performed by a specialist plastic surgeon and any suspicious lesions were recorded and, if necessary, recommendations for further treatment was documented.Results: The number of individuals screened was 3397. Of these, 572 patients were referred to general practitioners for further medical attention of suspicious lesions, 79 patients were clinically diagnosed as having suspicious pigmented skin lesions (13.8% of total lesions and 2.3% of total sample screened). Of these, 53 individual patient pathology reports were obtained. Four invasive malignant melanomas and two in situ melanomas arising in Hutchinson's melanotic freckles were detected.Conclusions: Debates concerning the efficacy of screening for skin cancer have recently received great attention from many medical disciplines. However, as yet the effectiveness of population based skin cancer screening programmes have not been adequately evaluated with randomized controlled studies. The study reported here provides some findings that may be used to enhance future screening studies.
PROLONGED SURVIVAL FOLLOWS RESECTION OF OESOPHAGEAL SCC DOWNSTAGED BY PRIOR CHEMORADIOTHERAPY
Authors: Bessell J. R. , Devitt P. G. , Gill P. G. , Goyal S. , Jamieson G. G. 
Published: January 2008

Background: The poor survival rate of surgically treated patients with oesophageal cancer has not improved substantially over the last 25 years, but combined modality therapy has shown early promising results.Methods: A prospective study was undertaken to determine the effect of pre‐operati ve synchronous chemoradiotherapy followed by oesophagectomy in 53 patients with squamous cell carcinoma (SCC) of the oesophagus. The patient group was unselected, other than by fitness for surgery.Results: In 25% of patients, complete pathological regression of the tumour was achieved. All but one of the patients in this subgroup had T2 tumours on pre‐operative clinical staging and two had evidence of lymph node involvement, but postoperative pathological examination revealed that pre‐operative chemoradiotherapy had downstaged their disease to TONO. There was no hospital mortality in this subgroup and the actuarial 7 year survival was 69%.Conclusions: For squarnous oesophageal tumours deep to the submucosa this is an extremely good survival. For the present, this form of therapy for SCC of the oesophagus appears capable of achieving results comparable to, or better than, those reported for 3‐field lymphadenectomy.
THE MORBIDITY OF DEFUNCTIONING STOMATA
Authors: Chen Frank , Stuart Malcolm 
Published: January 2008

Background: The choice of a defunctioning stoma in restorative resection of rectal carcinoma is unclear. Traditionally, the loop colostomy has been preferred.Methods: All patients with either a defunctioning loop ileostomy or colostomy treated by a single surgeon (MS) were studied. The morbidity of stoma construction and closure, as well as problems experienced in the intervening period, were entered on a database.Results: No significant difference in the morbidity of closure was noted when loop ileostomy was compared to loop colostomy. Although a trend favouring loop ileostomy was noted when interval morbidity was examined, this difference was not statistically significant.Conclusions: Loop colostomy and ileostomy are both effective in defunctioning the distal colon following a restorative resection for rectal carcinoma. There is some morbidity associated with both but when a stoma is constructed, loop ileostomy is preferable. The loop ileostomy is generally easier to manage and is not associated with a greater rate of complications (in its construction and closure) than the loop colostomy.
NON‐TUBERCULOUS MYCOBACTERIAL LYMPHADENITIS
Authors: Wright J. E. 
Published: January 2008

Background: Non‐tuberculous mycobacterial lymphadenitis has been recognized since medieval times by an array of names. The condition is familiar to paediatricians and paediatric surgeons but it often is not recognized in its early stages. A paediatric surgeon's experience of the condition in Newcastle over 30 years is reviewed.Methods: A personal series of children with non‐tuberculous mycobacterial lymphadenitis treated in Newcastle from 1966 to 1994 is reviewed. Clinical diagnosis was supported by multiple Mantoux skin testing in most patients using human purified protein derivative (PPD) and avian antigens. All were treated surgically with histological confirmation of the diagnosis. A total of 89 patients were encountered. Twenty‐two were seen in hospital practice between 1966 and 1976 and have already been reported. The current paper presents the results of analysis of the clinical features, diagnosis and surgical treatment of the remaining 67 patients seen in paediatric surgical practice between 1976 and 1994.Results: There was equal sex distribution. Ages ranged from 1 to 10 years, with none under 1 year, and 82% of the patients were in the pre‐school age group. Cervical lymph nodes were involved in all, the majority being jugulo‐digastric or subman‐dibular. Surgical excision by limited dissection of lymph nodes was performed in 55 patients with one recurrence, and by excision and curettage in eight patients with two recurrences. Simple bacterial wound infection occurred in four patients and two had prolonged postoperative suppuration as a result of mycobacterial wound infection. Paresis of the mandibular or cervical branch of the facial nerve occurred in 50% of patients where the nerve was at risk, but the majority of these recovered although it took over 6 months in some children. Culture for mycobacterial organisms was positive in only 29 patients.Conclusions: The diagnosis of non‐tuberculous mycobacterial lymphadenitis is clinical and its early recognition requires an awareness of the condition. It can be confirmed by multiple Mantoux testing or fine needle aspiration biopsy. The treatment is local excision of the affected lymph nodes. Histological examination and mycobacterial culture should be performed.
CAROTID ARTERY SURGERY IN THE OCTOGENARIAN
Authors: Thomas Philip C. , Grigg Michael 
Published: January 2008

Background: The value of carotid surgery is largely dependent on the safety of the procedure. With changes in population life expectancy, increasing numbers of elderly patients are being considered for surgery.Methods: In the present paper, the results of 113 patients (octogenarians: > 80 years of age) who underwent carotid endarterectomy in the 17 years prior to 1994 are reported. This group composed 6.2% of the 1818 patients treated in the period, 665 (36.6%) operations were performed on patients 50–65 years inclusive and 1040 (57.2%) on patients aged 66–80 years inclusive.Results: The overall peri‐operative stroke rate was 2.5% and the postoperative mortality was 1.9% with no statistical difference apparent between the age groups despite hemispheric strokes being the most common indication for operation in the octogenarian group (29.5%) and the least common indication in the youngest age group (16.2%, P < 0.01).Long‐term follow up (2–7 years) of octogenarian patients undergoing carotid surgery suggested maintenance of pre‐operative levels of living independence.Conclusions: The results of the study indicated that octogenarian patients should not be denied carotid endarterectomy on the basis of age alone and that results comparable to those of younger patients can be anticipated.
P53 TUMOUR SUPPRESSOR GENE EXPRESSION IN HYPERPARATHYROIDISM
Authors: Subramaniam P. , Wilkinson S. , Shepherd J. J. 
Published: January 2008

Background: Mutations of the p53 tumour suppressor gene lead to the loss of control of normal cellular proliferation and differentiation and have been shown to be associated with the development of malignancy.Method: Archival paraffin resection specimens from 86 cases of hyperparathyroidism treated surgically using the rabbit poly‐clonal CM1 antibody were investigated to detect p53 immunoreactivity in these sections.Results: Eighteen of the 86 sections examined (21%) showed nuclear immunoreactivity. No correlation was detected between tumour histology and p53 immunoreactivity (P = 0.45). nor was there any correlation between tumour clonality and immunoreactivity (P = 0.54). Multiple endocrine neoplasia type I (MEN 1) status did not correlate with p53 immunoreactivity. A significant correlation between p53 immunoreactivity and preparathyroidectomy calcium levels of > 1.5 mmol/L was detected (P < 0.005) although no correlation was noted between p53 immunoreactivity and higher levels of preparathyroidectomy intact parathyroid hormone (PTH) levels.Conclusion: A relationship is postulated between abnormal serum calcium regulation and p53 mutation in hypercalcaemic states associated with hyperparathyroidism.
PRIMARY REPAIR FOR COLONIC GUNSHOT WOUNDS
Authors: Velmahos George C. , Souter Irene , Degiannis Elias , Hatzitheophilou Costas 
Published: January 2008

Background: Penetrating injuries of the colon have been managed traditionally by diverting colostomy. Recently, a trend towards primary repair has been observed, particularly for knife injuries. The purpose of this study is to evaluate the safety of primary repair for colonic gunshot wounds in the presence of certain clinical risk factors.Methods: A retrospective analysis of 223 patients with colonic bullet injuries in a period of 3 years (1990–93) was performed.Results: Of 223 patients with colonic trauma, 168 were primarily repaired (group A) and 55 underwent a colostomy (group B). Intra‐abdominal septic complications occurred in 5.9% of group A patients and 10.9% of group B patients (P > 0.05, NS). These patients were, furthermore, stratified according to well‐known risk factors for the development of complications, namely, site of injury, presence of shock on admission, degree of faecal contamination and number of associated injuries. We were unable to find any statistically significant differences in intra‐abdominal septic complication rates between patients treated with primary repair and patients treated with colostomy.Conclusions: Primary repair seems to be a safe therapeutic option for gunshot wounds of the colon. Even in the presence of the abovementioned risk factors, colostomy may be avoided in most cases as primary repair does not appear to be associated with higher complication rates.
STIMULATED GRACILIS NEOSPHINCTER: A NEW PROCEDURE FOR ANAL INCONTINENCE
Authors: Kennedy M. L. , Nguyen H. , Lubowski D. Z. , King D. W. 
Published: January 2008

Background: The gracilis muscle has been used previously to construct an anal neosphincter, but this was not successful since a short‐lived muscle contraction was insufficient to restore continence. Recently, a procedure was described in which conversion to a fatigue‐resistant muscle was achieved by chronic low frequency electrical stimulation, and the resultant ability to sustain a constant contraction was associated with improved continence. Our initial results with this procedure, using a standardized operation and treatment protocol in 12 consecutive patients. is reported.Methods: Seven women (mean age 50 years, range 22–71 years) had faecal incontinence, and five patients (F:M. 3:2; aged 53–72 years) underwent reconstruction after abdominoperineal excision of the rectum for cancer. A detailed questionnaire including continence score was completed pre‐operatively. Eight patients have been assessed after ileostomy closure at a mean time of 10 months.Results: Slow‐twitch muscle conversion was achieved in each case and all patients have a functional neosphincter. Mean continence score was 6.8 (range 4–12), and seven patients were continent. There was significant improvement in continence in the non‐cancer group (p= 0.03). Mean pre‐operative resting anal pressure, functional neosphincter pressure (NPfunc), and maximal neosphincter pressure (NPmax) were 36, 102 and 207 cmH2O, respectively. There was a significant improvement in pressure comparing NPfunc (P= 0.03) and NPmax (P= 0.03) with pre‐operative pressure. Complications included deep vein thrombosis. pulmonary embolism, saphenous nerve injury, leg wound haematoma, and late pacemaker infection.Conclusion: The stimulated gracilis neosphincter achieves satisfactory continence in a majority of patients.
COMPLETION TOTAL THYROIDECTOMY IN THE MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMA
Authors: Agarwal A. , Mishra S. K. 
Published: January 2008

Background: Completion thyroidectomy is the removal of any thyroid tissue that remains after a less than total thyroidectomy. This procedure has been commonly performed when the final histopathology of the excised ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Complete thyroidectomy carries little morbidity if performed by experienced surgeons using a lateral approach. The purpose of this study is to reinforce the usefulness of a lateral approach.Methods: A retrospective analysis over a 5 year period at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) yielded 19 patients who underwent completion thyroidectomy. This group represents 23% of 82 patients who underwent total thyroidectomy for differentiated thyroid cancer (DTC) during that period. The residual thyroid tissue was excised through a lateral approach and could be resected safely, preserving the recurrent laryngeal nerve (RLN) and the parathyroid glands.Results: A lateral approach dissection could be performed with ease in a virgin area. Excision of residual thyroid tissue could be performed safely even in cases with prior partial lobectomy or bilateral subtotal resection. Tumour was found in 52% of the re‐operative specimens: in three out of four of those after a previous partial lobectomy, in six out of 12 of those after a total lobectomy, and in one out of three of those after a prior bilateral (although incomplete) thyroid resection. Postoperative complications included transient RLN palsy (n = 2) and transient hypoparathyroidism (n = 4).Conclusions: Completion thyroidectomy using a lateral approach is safe in re‐operative thyroid surgery.
ARTERIAL INJURY IN THE LOWER LIMB FROM BLUNT TRAUMA
Authors: Faris I. B. , Raptis S. , Fitridge R. 
Published: January 2008

Background: The present study was performed to identify the factors associated with amputation in patients with blunt injuries to the lower limb associated with arterial injury. The ability of a scoring system to predict the outcome was tested. Methods: There were 122 lower limb arterial injuries in 119 patients treated at the Royal Adelaide Hospital in the years 1962–1994. Prognostic factors considered were the site of the injury, the severity of the soft‐tissue injury and shock, the presence of associated injuries and a description of the bone or joint injury. The mangled extremity severity score (MESS) was calculated retrospectively for each patient. Results: The outcome was primary amputation in 27 patients, delayed amputation in 36 patients and limb salvage in 59 patients. The seven deaths were all due to associated injuries. Factors associated with amputation were the severity of shock and soft‐tissue injury (P<0.01), and tibial artery injury compared with more proximal injury (P<0.001). Factors that did not affect outcome included delay before repair, method of fracture fixation, or performance of fasciotomy. Amputation was performed in 48/71 (68%) patients with Gustilo type‐IIIC fractures of the tibia. Applying the MESS to our patients resulted in a positive predictive value (PPV) of 71%, a negative predictive value (NPV) of 84% and an overall accuracy of prediction of 75%. Conclusions: The major factor determining outcome was the severity of the soft‐tissue injury. Progressive necrosis and infection was a major cause of late amputation. The MESS is not sufficiently precise to allow the decision regarding amputation to be made at the initial operation.
EXPERIMENTAL SKELETAL MUSCLE GRAFTS AS A MODEL OF REGENERATION
Authors: Lawson‐Smith Matthew J. , McGeachie John K. 
Published: January 2008

Background: It is now well established that mature skeletal muscle has the ability to regenerate, and reports on this phenomenon have existed in the research literature for some 40 years. However, it is only relatively recently, largely due to the advances in microsurgery, that practising surgeons can make direct use of the regenerative ability of skeletal muscle. Methods: Most of the key data on skeletal muscle regeneration have come from experimental studies on muscle grafts in small animal models. One such model is the transplantation of the extensor digitorum muscle of the mouse or rat into the contralateral site, or the relocation of this muscle onto the surface of the tibialis anterior muscle. These and other models, together with the important cellular mechanisms involved in the regeneration of skeletal muscle, are reviewed briefly in this article. Results: Skeletal muscle cells regenerate rapidly in muscle grafts, arising from satellite cells in the surviving peripheral fibres of the graft within 2 days after grafting. The resultant myoblasts progress towards the necrotic graft centre and occupy the area by 5 days. Revascularization commences at 3 days after grafting, but reinnervation takes many weeks to complete. Conclusions: With the established knowledge on skeletal muscle regeneration, largely gained from experimental studies of muscle grafts, an understanding of these mechanisms should now be fundamental knowledge for today's practising surgeons.
PSYCHIATRIC DISTURBANCE AND ACUTE STRESS RESPONSES IN SURGICAL PATIENTS
Authors: Clarke David M. , Russell Prudence A. , Polglase Adrian L. , McKenzie Dean P. 
Published: January 2008

Background: A number of reports have appeared of post‐traumatic stress symptoms occurring in physically ill patients. This study sought to measure the extent of psychiatric disturbance and acute post‐traumatic stress reactions occurring in surgical inpatients, and to examine their relationship with the stress of illness and hospitalization and the personal coping style of the patient. Methods: Thirty‐seven admissions to a general surgical unit were assessed on admission and immediately prior to discharge. Measures were made of depression, anxiety, cognitive impairment, post‐traumatic stress symptoms, severity of illness, level of physical functioning, degree of hospital stress and coping style. Results: There was a significant reduction in anxiety scores postoperatively. Twenty‐seven per cent of patients developed high levels of acute post‐traumatic stress symptoms and these correlated with depression at admission and intra‐hospital stress. Depression at discharge was related to depression at admission, physical functioning and coping style. In general, avoidance and acceptance‐resignation were associated with a poorer psychiatric outcome. Conclusions: Postoperative psychiatric disturbance, including acute stress symptoms, can be understood as a reaction to the ‘trauma’ of illness and hospitalization, predisposed to by pre‐existing depression. Interventions could be directed at screening for at‐risk patients, minimizing stress, and encouraging adaptive mechanisms of coping in patients.
THE EFFICACY OF OPEN LUNG BIOPSY
Authors: Neuhaus Susan J. , Matar Kevin S. 
Published: January 2008

Background: The morbidity and mortality of open lung biopsy was assessed, and the ability to provide a specific diagnosis in the assessment of patients with diffuse radiographic pulmonary infiltrates was determined. Methods: A retrospective analysis was undertaken from January 1990 to May 1995 of all patients undergoing open lung biopsy during the study period. A total of 127 biopsies were performed. The indications were diffuse, infiltrative or multinodular disease. Forty‐two (33%) patients had previously undergone non‐diagnostic trans‐bronchial biopsy. Results: Open lung biopsy obtained a histological diagnosis in 121 (95.3%) patients. Postoperative in‐hospital mortality was 4.7% (six patients). Three of the four patients being ventilated at the time of biopsy died. Thirty‐six (28.3%) patients suffered one or more morbid events. Patients with decreased lung function, as measured by forced expiratory volume, experienced a higher risk of a morbid event (P < 0.01). There was no significant correlation between the chance of a morbid event and age, sex or the use of multiple biopsy sites. A presumptive diagnosis was made prior to biopsy in 71 patients (55.9%) and was proven correct in 43.6% of cases. Conclusions: Open lung biopsy in patients with diffuse pulmonary disease is an accurate diagnostic tool and has an acceptable morbidity and mortality associated with the procedure.
RESULTS OF OPEN CARPAL TUNNEL RELEASE: A COMPREHENSIVE, RETROSPECTIVE STUDY OF 188 HANDS
Authors: Thurston Alan , Lam Nicholas 
Published: January 2008

Background: Many recent reports of the results of decompression of the median nerve in the carpal tunnel have concentrated on only one aspect of recovery (numbness, grip etc.), and there are no reports of a comprehensive study of outcome. The aim of the present study was to review comprehensively the results of the direct visualization method of decompression of the carpal tunnel and to compare them with the published results of endoscopic release. Methods: Patients' perceptions of the severity of pain, numbness and paraesthesiae due to carpal tunnel syndrome (CTS), before and after open carpal tunnel release (CTR) in 188 hands were reviewed retrospectively at a minimum time of follow‐up of 18 months. Motor and sensory testing, provocation testing and measurement of scar tenderness in 135 hands were performed at a clinical review. Results: Subjective results showed that 70% experienced a reduction in the severity of pain after CTR, 78% of hands experienced a reduction in the severity of paraesthesiae and 77% experienced a reduction in the severity of numbness. A total of 49% had improvements in all three symptoms after CTR. At the clinical review, sensory testing revealed that 59% of hands had normal or slightly diminished light touch, 35% had normal static two‐point discrimination and 61% had normal dynamic two‐point discrimination. Results for Tinel's test, Phalen's test and pressure provocation testing were positive in 10% of hands. There was no scar tenderness in 38%, no persisting thenar atrophy in 90%. Normal grip strength was found in 93% and 91% had normal pinch strength. Conclusions: It was concluded that open carpal tunnel release remains a safe and reliable treatment for carpal tunnel syndrome. The very low incidence of serious complications from the open technique of CTR, when compared with endoscopic CTR as published by different authors in the literature, and the comparable clinical results, appears to make the open technique a safer and preferable option. However, a properly controlled trial of both techniques is necessary to compare them.