bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experimental Gut Anastomoses and Their Revascularization
Authors: Nakanishi H. 
Published: January 2008

A study was made of the healing and revascularisation of intestinal anastomoses in the small and large intestines of rabbits. Single‐layer and double‐layer suture techniques were used and compared, and revascularization of the anastomoses was particularly examined after devasoularization of their distal segments. The anastomotic segments were removed at intervals after construction varying from one to six zveeks and studied histologically after hematoxylin and eosin staining, by xylol‐clear thick sections and by angiography, a gelatin Micropaque emulsion being used to fill the vascular network.Forty‐four rabbit intestinal anastomoses were studied. Inverted intestinal anastomoses look about two weeks to develop continuous mucosa on the luminal side, and were completely healed after six zveeks. Revascularization began after eight days with both single‐layer and double‐layer anastomoses, proceeding from the submucosal and the surrounding muscular layers. The vascular pattern mirrored the healing stage of the anastomosis. Irregular fine vessels crossing the anastomoses were seen in specimens examined at the second week. After three or four weeks, the vascular patterns of. the anastomoses showed an irregularity of calibre and direction because of the presence of residual scar tissue, and the mucosal surfaces were covered with regenerating epithelium. Healing and revascularization were complete after six weeks.
A REVIEW OF OBSERVATIONS ON CHRONIC GASTRIC ULCER PATIENTS IN AUSTRALIA
Authors: PIPER D. W. , THOMAS J. H. , GREIG M. , KANG J. Y. , MclNTOSH J. 
Published: January 2008

A study has been made of demographic and extragastric variables in a gastric ulcer population; a comparison has been made with a control community population matched for age, sex and social grade.There are 600–700 ulcer deaths annually in Australia, chiefly due to bleeding. Those who die of an ulcer have their lives shortened by 13 years on the average, and the yearly cost of ulcer disease in Australia is approximately $174,000,000.As has been observed previously, there is a predominance of females in the gastric ulcer population, with a male:female ratio not exceeding 1 at all ages; in other countries, the ratio is 2–3:1.Female ulcer patients take analgesics more commonly and male ulcer patients smoke more commonly and drink less commonly than controls. Gastric ulcer is not associated with any characteristic personality traits nor is it associated with emotional stress. Patients with gastric ulcer tend to occupy positions of lower social grade and show social incongruity. Ulcers in smokers tend to be situated in the lower third of the stomach, but alcohol and analgesic ingestion do not influence ulcer site.The complete healing of an ulcer favourably alters its course for at lest four years. If it has healed, smoking, analgesics and alcohol exert no adverse effect. Socially, ulcer patients tend to be single, and on diagnosis gastric ulcer is associated with considerable social disability; with medical or surgical treatment, this disability disappears six months later.With the aid of early endoscopy, intensive care ward supervision and planned surgery, the mortality from acute upper gastrointestinal haemorrhage due to ulcer has fallen, now being les than 5% overall and less than 1% in those less than 60 years of age.
BILE DUCT INJURY DURING CHOLECYSTECTOMY: CAUSES, PREVENTION AND SURGICAL REPAIR IN 1979
Authors: KUNE GABRIEL A. 
Published: January 2008

Bile duct injury during cholecystectomy is almost always a high Injury of the proximal common hepatic duct, because the surgeon mistakes this duct for the cystic duct and a segment of it is removed with the gallbladder. Most of these injuries are preventable by following certain principles of careful surgical dissection of the ductal system during surgery. Surgical reconstruction is always difficult, and restrlcturing of the anastomosis remains the most important problem. Recent advances in surgical technique have minimized the risk of recurrent stricture formation. At present the most suitable reconstruction for the typical high common hepatic duct lesion is a hepaticojejunostomy Roux‐en‐Y, using transhepatic intubation and a “mucosal graft” type of procedure. Biliary reconstruction was performed on 32 patients referred to the writer during the past 13 years resulting In six recurrent strictures needing a second reconstruction. At the end of 1978,10 patientsare too early to evaluate, two are dead and 20 have obtained a good final result.We must publicise the fact that cholecystectomy is a dangerous operation THE LATE DR. FRANK H. LAHEY
MORTALITY AND COMPLICATIONS OF LARGE‐BOWEL RESECTION FOR CARCINOMA1
Authors: THEILE D. E. , COHEN J. R. , HOLT J. , DAVIS N. C. 
Published: January 2008

The mortality and complications of large‐bowel resection for carcinoma performed at the Princess Alexandra Hospital since the Colorectal Project commenced in 1971 are reviewed and compared with the results in other published series.There were 443 patients in this prospective study, and 375 underwent resection of their tumour. The overall operative mortality was 6.4% ‐ for colonic lesions it was 8.0% and for rectal 3.4%. The mortality for elective curative resections was 2.6%, and for emergency resections it was 10.8%. The anastomotic leak rate was 6.8%, but was higher (16.6%) when the anastomosis was done at the time of emergency resection. No patient whose anastomosis leaked but who had had a previous defunctioning proximal colostomy died. There was a wound infection rate of 15.1%.
RECTAL PROLAPSE
Authors: FAILES DAVID , KILLINGBACK MARK , STUART MALCOLM , LUCA CATHERINE DE 
Published: January 2008

One hundred and twenty‐seven patients with complete rectal prolapse have been reviewed. The condition occurred more commonly in females than males (105 to 22), and at an older age in females (mean age 55 years compared with 40 years for males). Although the diagnosis is usually obvious, the importance of recognizing occult prolapse is stressed, especially in association with benign rectal ulcer, localized proctitis and colitis cystica profunda. Examination of the patient in the squatting position may assist in showing occult prolapse. Associated incontinence occurred in 33 patients (26%).Since 1971 the policy of this Unit has been to perform a Ripstein repair for complete rectal prolapse wherever possible. One hundred and two Ripstein repairs have now been performed. A minimum follow‐up period of two years is available for 53 patients, of whom 50 (94%) have had their prolapse cured. Control of prolapse usually improves continence; however, seven (13%) remained incontinent despite surgery. The Ripstein. repair is strongly advocated as the most effective operation for cure of complete rectal prolapse.
THE PECTORALIS MAJOR MUSCLE IN HEAD AND NECK RECONSTRUCTION
Authors: Robertson Malcolm S. , Allison Robert S. 
Published: January 2008

From June 1980 to June 1985 51 pectoralis major muscle flaps have been used for one‐stage reconstruction of extensive defects in the head and neck following cancer surgery. The pectoralis major muscle was used as a myocutaneous flap on 28 occasions, as a muscle covered with split thickness skin on 17 occasions, and as a muscle‐only flap six times. The muscle, in its various forms, was used for reconstruction of the pharyngo‐oesophageal segment, the tongue, floor of the mouth and oropharynx, to replace the skin of the face and neck, and to provide a well vascularized recipient bed for a split‐rib graft, used to replace a defect of the anterior arch of the mandible.Many of the problems associated with the use of a pectoralis major myocutaneous flap can be avoided by the judicious use of a muscle flap on its own or covered by a split thickness skin graft.
MANAGEMENT OF ASCENDING AORTIC DISSECTION: EXPERIENCE WITH THE USCI* INTRALUMINAL PROSTHESIS AND A METHOD OF AORTIC VALVE REPAIR
Authors: Chard R. B. , Nunn G. R. , Johnson D. C. , Cartmill T. B. 
Published: January 2008

Ten consecutive cases of acute ascending aortic dissection operated on using the usci intraluminal prosthesis from 1983 to 1986 were reviewed. Diagnosis was achieved by conventional angiography in six cases, by intra‐arterial digital subtraction angiography in one case, by computerized tomography (ct) scan in two cases and by echocardiography and abdominal ultrasound in one case. An entry site was seen in only five out of six conventional angiograms. At operation six of the 10 had a degree of tamponade. Aortic regurgitation was seen five times, due to dissection in four cases and to marian's disease in one. The entry site was controlled in eight cases. Repair using intraluminal prosthesis only was achieved in five cases. Aortic valve repair was added in four out of 10 cases, and in one of these an aorta‐to‐right coronary graft was also added. One case required aortic valve replacement. A method of aortic valve repair is presented. There were nine survivors, 1–36 months postoperatively. Of these, eight were asymptomatic on no medication. One had severe aortic regurgitation noted 2 months postoperatively and has mildly reduced exercise tolerance.Surgical treatment can be planned if the presence of dissection is proven and involvement of the ascending aorta is demonstrated. Early surgery is important, since six of the 10 cases in this series had tamponade. The intraluminal graft will reliably redirect flow to the true lumen and exclude the dissection from the pericardium. Aortic valve repair can be successful though late replacement may be necessary in some cases. Control of the entry site is not essential to achieve a good clinical result.
VEIN TO ARTERY ALLOGRAFTS EXPERIMENTAL EVIDENCE OF IMMUNOLOGICAL SENSITIVITY IN RATS
Authors: Prendergast FrancisJ. , Mcgeachie JohnK. , Storrie ElizabethA. 
Published: January 2008

Vein allografts were studied in rats using the major histocompatibility complex‐incompatible da (rtia) and lew (rti1) inbred strains. Allografts from da rats were inserted in to 22 lew hosts, and vice versa, by interposing a 5 mm segment of donor iliolumbar vein into a defect in the host's iliac artery (i mm in diameter). Using microsurgical techniques. Grafts were left in siru for 6 weeks and were then tested for evidence of sensitization by the insertion of an allogeneic fetal heart from the donor strain into the host's foot pad. The fetal hean beat was recorded with an ecg and the time of rejection determined by the cessation of ecg activity. As controls, allogeneic donor fetal hearts were implanted into 40 host rates (20 of each strain) which had not previously received a donor vein allograft. These were monitored by ecg. As above.Control lew host rats rejected da fetal hearts in a mean time of 8.45 days. Control da hosts rejected lew fetal hearts in 8.70 days. Da hosts with lew vein allografts did not reject donor fetal hearts significantly sooner (mean 8.33 days) than the controls. However, lew host rats with allografted da veins rejected subsequent da fetal hearts in 7.18 days, which was significantly sooner than in controls (8.45 days). These data provide evidence of sensitization of the rejection response by vein allografts.
THE USE OF THE RIGHT GASTRO‐EPIPLOIC ARTERY IN CORONARY ARTERY BYPASS GRAFTING
Authors: Carter M. J. 
Published: January 2008

Thirty consecutive patients with angina pectoris undergoing coronary artcry bypass grafting using the proximally attached right gastro‐epiploic artery are described.Posterior coronary arteries were grafted using the right gastro‐epiploic artery, and grafts to the left coronary artery were done using predominantly internal mammary artery grafts. The right gastro‐epiploic artery graft is mobilized along the greater curvature of the stomach, and transected distally. With cardiopulmonary bypass and blood cardioplegic arrest for myocardial preservation during cross‐clamping of the aorta, the distal end of the artery is anastomosed end‐to‐side to the posterior descending artery or a postero‐lateral branch, or to both, using a sequential technique. Twenty‐five of the patients complained of symptoms suggestive of angina early postoperatively but are currently symptom‐free with normal excercise tolerance.Thirteen patients had postoperative exercise tests: eight were normal, two were inconclusive, and three were abnormal. Nine grafted coronary arteries were re‐angiogrammed, and seven were judged to be patent. It is concluded that, as an alternative resource, the right gastro‐epiploic artery can be used to bypass coronary obstructions expeditiously and with results comparable to those obtained with the saphenous vein or internal mammary artery.
THE USE OF PRE‐OPERATIVE SCAN PRIOR TO NECK EXPLORATION FOR PRIMARY HYPERPARATHYROIDISM
Authors: Wu Daniel T‐D. , Shaw James H. F. 
Published: January 2008

A group of patients with diagnosed primary hyperparathyroidism (PHP) in Auckland between 1982 and 1986 is reviewed. Of the 119 patients, 55 had pre‐operative scanning, 36 had no scanning prior to surgery and 29 were managed conservatively.Of the 52 patients who had pre‐operative localization with ultrasound scanning, only 27 (52%) had their adenoma correctly predicted upon neck exploration. Of the 14 patients investigated with thallium‐201 and technetium‐99m (Tl/Tc) subtraction scanning, 10 (71%) had their adenoma positively identified in the predicted locations, whereas the cause of the parathyroid pathology was correctly identified in 33 of the 36 patients (92%) who had surgery alone with no pre‐operative scanning.In 11 patients both ultrasound and Tl/Tc subtraction scanning were employed. In eight patients the results of the two scanning modalities agreed, and in seven of these eight patients the adenoma was correctly predicted (six single adenomas and one with double adenoma). In the three patients in whom the results of the two modalities differed, the Tl/Tc subtraction scanning correctly predicted the site of the adenoma in two patients and in the third patient (with a small 223 mg adenoma) both modalities were incorrect.Of the six patients with histologically proven parathyroid hyperplasia, only three had pre‐operative localization with ultrasound alone, and all three had incorrect predictions (one false positive for adenoma, and two false negative scans).Overall the results cast doubt over the usefulness of pre‐operative scanning as a routine investigation prior to initial neck exploration for primary hyperparathyroidism. However Tl/Tc subtraction scanning in particular may be useful in aiding surgical decision making for patients undergoing ‘redo’ neck exploration. Pre‐operative scanning was unhelpful in detecting hyperplasia. In the detection of adenomas Tl/Tc subtraction scanning was superior to ultrasound (71% vs 52%), but when both scanning modalities were employed, and both yielded the same results, the position of the adenoma was correctly predicted in seven out of eight cases. The results also emphasize the importance of the 24 h urinary calcium determination as part of the work‐up of the hypercalcaemic patient.
EXTERNAL FIXATION OF COMPLEX OPEN HUMERAL FRACTURES
Authors: Choong Peter F. M. , Grifrths John D. 
Published: January 2008

Seven cases of complex open humeral fractures treated by external fiation are reported. The external fixation allowed the associated injuries to nerves, arteries and soft tissues to be adequately treated. Four cases developed non‐union and of these, three cases treated by bone‐grafting and plating united, but the one case treated by intramedullary nail without bone‐graft did not unite.Frame construction and pin placement are discussed. The recommended plan for treatment of these fractures is initial external fixation until adequate soft tissue healing is achieved and sepsis controlled. Then early bone‐grafting and plating is advocated if there is no progressive fracture healing. The problems and advantages encountered in the use of external fixation are also described.
GALLSTONES AT AUTOPSY AND CHOLECYSTECTOMY: A COMPARATIVE STUDY*
Authors: Vtetta. L. , Sali A. , Chou S. T. , Fleming H. , Little P. , Elzarka A. 
Published: January 2008

An examination of 613 post‐mortems gave a prevalence of biliary disease at autopsy of 36.5%. higher than reported previously in Australia. This consisted of an asymptomatic gallstone prevalence of 18.9%. with a further 5.78 of the autopsies having granular biliary sludge and 11.9% having had a previous cholecystec‐toniy. Although the rate of occurrence of cholesterol gallstones was approximately half that of the pigment gallstones and pigment biliary sludge combined. no significant association between the sex of the postmortems and stone type was observed at autopsy (χ21= 0.1; P > 0.05). The ratio of biliary disease between females and males was approximately 2:1.Gallstones and biliary sludge from 310 cholecystectomy patients showed that cholesterol gallstones were approximately twice as common in men, and approximately six times as common in women than pigment gallstones. In this group of patients there was a significant association between the sex of the patient and the rate of occurrence of stone type. The rate of occurrence of cholesterol gallstones was significantly higher than pigment gallstones in both the males and females at cholecystectomy (χ21= 18.97; P < 0.0001). A female to male ratio of approximately 2:1 was also observed. A statistically significantly higher rate of pigmented biliary disease was observed at autopsy than at cholecystectomy. (χ21= 101.0; P< 0.0001). Analyses on biliary sludge. a filterable, fine granular pigmented material in bile. suggest that it may be the direct precursor for a number of different gallstone types.
PATHOGENESIS OF POSTOPERATIVE HYPONATRAEMIA FOLLOWING CORRECTION OF SCOLIOSIS IN CHILDREN
Authors: Cowley D. M. , Pabari M. , Sinton T. J. , Johnson S. , Carroll G. , Ryan W. E. 
Published: January 2008

Eight pediatric patients undergoing major surgery for correction of scoliosis who were treated postoperatively with hypotonic saline and 5% dextrose have been studied. Plasma sodium. renin and aldosterone. and urine volume. sodium and osmolality were measured.These patients had an impaired ability to excrete a sodium‐free water load. In the first 60 h urine volume remained reduced, while in the first 36 h urine sodium remained concurrently high. If the first 36 h post‐operation are considered, the sodium‐free water given was quantitatively retained and the serum sodium at 36 h was significantly correlated with the amount of free water given (P < 0.01).To minimize postoperative hyponatraemia and the associated shift of water into the brain causing cerebral oedema. it is recoinniended that no more than 50 ml/kg sodium‐free water be given until urine sodium falls and volume increases.
UNDESCENDED TESTIS: HOW HISTORY AND EXAMINATION MAY INFLUENCE TREATMENT
Authors: MacKellar A. 
Published: January 2008

This paper reports a prospective study of 114 boys with 126 undescended testes. The aims were to identify the position of the testis in the first year of life, to document cases of apparent ascent of the testes following a scrotal position in infancy. and to determine whether knowledge of the position of the testis in infancy might be used as a guide in later management.In 92 instances the position of the testis at birth, at 6 weeks and at 1 year of age was recorded; 84 were considered undescended and eight were in the scrotum. There was no clear indication of the position of the testis in the remaining 34.When the position of the testis was known to be undescended from birth to the end of the first year, response to honnonal therapy was disappointing. However, when there was a history of prior descent or when there was no clear information about the position in the first year of life. response to hormonal therapy was rewarding (57%) and this therapeutic modality is recommended prior to surgery for this group of patients.
MITRAL VALVE REPLACEMENT IN CHILDREN
Authors: Raffa Hassan , Khateeb Huda Al , Tunis Taher 
Published: January 2008

Rheumatic fever leading to advanced valvular heart disease, in adults and children, is still frequently seen in developing countries. In the period 1981–87, 1137 patients underwent open heart surgery for either repair (489 patients), or replacement (639 patients) of defective cardiac valves. The experience with 75 children who underwent mitral valve replacement among this group is reviewed.The aetiology of mitral valve disease was rheumatic in 71, and infective endocarditis in four; 85% of the children were in NYHA functional class III, and 15% in class IV. Seven children had intra‐operative findings of rheumatic activity. Pure mitral regurgitation was seen in 41, while mixed mitral valve disease was observed in 34 children. Twenty‐seven children underwenl niitral valve replacement with lonescu‐Shiley bovine pericardial valves, and 48 with mechanical Bi‐leaflet valves. The operative mortality was 9.3%. and the actuarial survival rate, calculated by the Cutler and Ederers method, was 87% at 5 years.
CANCER OF THE TONGUE AND ORAL CAVITY IN AUCKLAND, NEW ZEALAND, 1970–86
Authors: Koea JonathanB. , Shaw JamesH. F. 
Published: January 2008

This report comprises a retrospective review of the clinical data on 157 patients seen in the auckland area having a diagnosis of cancer of the tongue, floor of the mouth, inferior alveolus, or buccal mucosa (retromolar area, vestibule of the mouth, and cheek mucosa) during 1970–86. One hundred patients were male, 95% were european, 85% were cigarette smokers, and 58% had a history of high alcohol intake. All primary tumours were squamous cell carcinomas, 50% were located in the tongue, 27% in the floor of the mouth, and 11.5% each in the buccal mucosa and inferior alveolus. The majority (60%) of patients with tongue cancer were clinically stage i at presentation while other intra‐oral tumours were evenly distributed between stages i and iv. Surgical resection of the primary intra‐oral lesion produced local control in 90% of stage i tumours, but this fell to below 70% in stage ii—iv tumours. Most patients (82%) who recurred locally had positive or ‘close’ margins, and this rate of local tumour recurrence as a consequence of narrow margins did not decrease with the addition of adjuvant radiotherapy. Of those patients with stage i disease who received only treatment of the primary lesion, 20% later developed regional nodal disease which was controlled in more than half by neck dissection, but control was achieved only in 11% of patients treated with radiation. The presence of regional disease at presentation was associated with a poor prognosis.It is concluded that local control of inferior oral cavity tumours can be achieved if resection is accomplished with clear margins. Regional control can be obtained in 50% of patients with neck dissection. Considered together, the high rate of regional recurrence with stage i lesions, and the poor results following salvage therapy (12% 2 year survival) indicate that these patients require as aggressive initial therapy (often involving neck dissection) as do those with more advanced disease.