bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perforated Peptic Ulcer: Mortality and Morbidity in 603 Cases
Authors: HENNESSY E. 
Published: January 2008

A retrospective study of 603 instance of perforated peptic ulcer occurring over the period from 1944 to 1964 is presented with reference to annual and seasonal incidence, sex ratios, mortality and the factors affecting it, and immediate morbidity. Of special note are: (a) the highly significant increase in the proportion of females in Newcastle, New South Wales; (b) the markedly lower pyloro‐duodenal: gastric ratio as compared with that reported in overseas figures; (c) a previously unreported relationship between the actual act of drinking chilled beer and perforation and (d) the very highly significant relationship between the death rate and the sise of the performation.SummaryA series of 603 instances of perforated peptic ulcer over a period of 21 years until 1964 is presented.There has been no real change in the relative incidence of perforation in gastric, pyloric and duodenal ulcers over that time interval, and none in the annual incidence. On the contrary, there has been a highly significant increase in the proportion of females, and the pyloroduodenal: gastric ratio in females is less than unity, a most marked variation from European figures.The seasonal incidence of perforated ulcer in Newcastle, Australia, is remarkably constant.A previously unreported relationship between the actual act of drinking chilled beer and perforation is noted.The overall mortality rate was 15.4%, 7.8% in patients who were operated on and 72.8% in those who were not. There was a single operative death among 80 females. In operations on males, gastric performations were the most lethal to a highly significant degree.Increase in age and delay in operation adversely affect the operative death rate.The prognosis is further worsened by perforation in hospital, posterior wall perforation, perforation associated with gastro‐intestinal hæmorrhage, admission to a non‐surgical service and, of course, mis‐diagnosis.A very highly significant relationship was noted between the death rate and the size of the perforation.The young seek advice earlier than the old, and males earlier than females.The immediate morbidity is high, with a postoperative pneumonia rate of 42.9% and a wound infection rate of 31.9%. A significant relationship is seen between subphrenic abscess and gastric perforation.
Air Embolism in Cardiac Surgery: Incidence and Prophylaxis1
Authors: NICKS ROWAN 
Published: January 2008

This is a brief review of some of the physiological consequences of air embolism, followed by a discussion of the results of a comparative study between two consecutive series of patients, the first prior to the introduction of the strict routines now practised, and the second after this had been introduced. The techniques in current use for prophylaxis against air embolism are presented.SummaryThe incidence and outcome of systemic air embolism occurring in 520 patients have been estimated from records of cerebral disturbance.Two series of patients are compared, the first prior to the introduction of strictly planned “debubbling”, and the second after this time. The comparisons shows a marked fall in the incidence and severity of this complication in the recent series.Techniques used for removal of air in specific operations have been presented.Pulmonary air embolism has been discussed. While no direct relationship between bilateral atelectasis and pulmonary air embolism has been shown, there is a strong probability that it has been in the past responsible for this, at least in some part and in conjunction with other factors.
Operative Cholangiography in the Surgery of Gallstones: Implementation of a Policy Decision in a Consecutive Series of 327 Patients
Authors: BURNETT W. , BOLTON P. M. 
Published: January 2008

Operative cholangiography was introduced with the major objectives of demonstrating previously unsuspected bile duct calculi, avoiding fruitless choledocholithotomy, and reducing the incidence of residual duct calculi. This report describes the effects on patient management of a policy of routine operative cholangiography in the surgery of gallstones in the Professorial Surgical Unit at the Royal Brisbane Hospital. All three objectives were realized, but for full achievement of the potential of the technique, skill, experience, and persistence are required by the surgeon, both to obtain satisfactory pxeexploratory and completion cholangiograms, and to remove all demonstrated calculi at the primary procedure.SummaryA review has been carried out of the effect on patient management of the use of routine operative cholangiography in a series of 327 patients undergoing surgery for gallstones in the Professorial Surgical Unit at the Royal Brisbane Hospital. Operative cholangiography was carried out in 82% of cases, and the technique failed in 16% of these. The reasons for failure are analysed. Operative cholangiography is a reliable and accurate method of predicting the presence of choledocholithiasis. It can dispense with the necessity for choledochotomy in a significant number of cases where clinical indications for duct exploration exist, and occasionally reveals a previously unsuspected stone. With cholangiography, the incidence of retained stone after cholecystectomy should approximate to zero. Completion cholangiography reduces the incidence of retained ductal stone after choledocholithotomy, but in order to reduce the incidence still further, skill, experience and persistence are required by the surgeon in obtaining an adequate cholangiogram, in the interpretation of the cholangiogram, and finally in the removal of the duct stones. It is recommended that operative cholangiography should be performed as a routine during biliary surgery.
Symposium on Aspects of Anal Continence1
Authors: BENNETT R. C. 
Published: January 2008

The significance of an adequate sensory mechanism in the maintenance of continence is stressed and a number of important considerations are reviewed. It appears likely that several factors play a part, perhaps in varying degrees under different circumstances. The muscles of the pelvic floor and the lining of the anal canal are both capable of assisting in the fincr degrees of localization and discrimination.SummaryIn summary, I believe that at present we can say that the sensory component of continence is subserved by the sequential recognition of the contents by the colon, rectum, pelvic floor and anal canal. The colon and rectum provide vague and diffuse sensation, with poor localization and poor discrimination. The pelvic floor provides the first means by which the acute urge to defæcate is appreciated, and also the first and perhaps most important means of discriminating accurately between various contents of the rectum. Similar sensory appreciation is mediated by the lining of the anal canal, and although the powers of discrimination are excellent and the sensitivity acute, this should be regarded as a rather late means of achieving recognition. Patients in whom one or more of the latter two mechanisms are disturbed might reasonably be expected to develop significant postoperative defects in continence. In most young patients with congenital deformities of the ano‐rectum, and in whom the anal canal has never been present, the pelvic floor is still able to act as an accurate sensory receptor. Furthermore, its capacity in this regard can be developed to such an extent that high‐quality function can usually be achieved. On the other hand, adult patients who suddenly lose the sensory capacity of the anal canal to which they have always been accustomed frequently develop functional defects of varying severity.
Nervous Pathways in Anorectal Control
Authors: STEPHENS F. DOUGLAS 
Published: January 2008

The normal individual is provided with highly sophisticated afferent and efferent nerve pathways to the rectum and the levator ani complex, the external sphincter and the internal involuntary sphincter, to maintain continence. Studies indicate that patients may gain near‐normal control when lacking certain anatomical components of these muscles and reflex arcs.The sphincters of the normal and abnormal states are described.
Functional Hydroureteronephrosis Associated with Prostatitis and Urinary Infection: Report of a Case
Authors: SHARMA S. K. , RAO M. S. , RAJU B. V. R. , RAO I. R. , SINGH S. M. 
Published: January 2008

Bilateral dilatation of the upper urinary tract in the adult male is not necessarily due to bladder neck obstruction requiring surgical treatment. It can be result of inflammatory disease, in which even it may well respond to conservative therapy. The case of a patient in this category is reported.SummaryThe presence of an insignificant amount of residual urine in combination with symptoms of prostatism and a radiologically demonstrated dilated upper tract should alert one to the possibility of these phenomena being of infective rather than of obstructive origin. A plea is made for the avoidance of hasty prostatic surgery and for the treatment of such patients on medical lines. A case report is presented to illustrate that this approach can be successful.
Ileocæcal Tuberculosis1
Authors: Prakash Atm , Sharma Lalit K. , Koshal Arvind , Poddar P. K. 
Published: January 2008

A retrospective study of 92 cases of ileocecal tuberculosis, carried out at the Institute Hospital, New Delhi, is reported. The maximum incidence of the disease appeared to be between the ages of 20 and 40 years. There were 57 females and 35 males in the series. The majority of patients had symptoms for more than a year before they presented for treatment.Varying grades of intestinal obstruction constituted the usual clinical presentation, 44% of patients having subacute and 16% acute intestinal obstruction. Perianal fistula and abscesses were not seen. Most patients had no evidence of pulmonary tuberculosis. Barium X‐ray studies were very helpful in the diagnosis. Bowel resection or short‐circuiting gave very satisfactory results.
A PROSPECTIVE STUDY OF 100 SPLENECTOMIES
Authors: LITTLE J. M. 
Published: January 2008

One hundred consecutive splenectomies, performed personally by the author, have been studied prospectively over a 10‐year period. Five Indications for splenectomy have been defined: therapeutic, diagnostic, Incidental, external trauma, and accidental damage at upper gastrointestinal surgery. Sixty of the patients were males. The mean age of the patients in the whole group was 36.5years. Those with idiopathic thrombocytopenic purpuraand those having staging laparotomy for Hodgkln's disease tended to be younger, while those with hypersplenism, leukaemia, and myelofibrosis comprised an older group. There were three deaths in the series. Sixty‐eight complications occurred In 49 patients. Complications were seen most frequently in those with hypersplenism and in those having splenectomy incidental to some other procedure. The frequency of complications rose with age. Three patients developed pericarditis, and attention Is drawn to the associated features of this puzzling postoperative syndrome. Thromboembolic complications were no more frequent than usual with upper gastrointestinal surgery, but prophylactic heparin was always given if the platelet count rose above 1,000,000/mm3.White cell response to splenectomy has been documented, and four different pattern of platelet response have been identified dependent on the underlying disease for which the splenectomy was performed.Two episodes of septicaemia occurring within two months of splenectomy have reemphaslzed that the immune disturbance occasioned by splenectomy may be significant in adults with serious underlying disease. It Is emphasized that technical care and awareness of the physiological disturbances are both necessary for the safe performance of splenectomy.
LOCAL EXCISION OF CARCINOMAS OF THE RECTUM, ANUS, AND ANAL CANAL
Authors: CUTHBERTSON A. M. , KAYE ANDREW H. 
Published: January 2008

Local resection has a place in the treatment of selected patients with carcinoma of the rectum, anus and anal canal. Selection depends on the ability of the surgeon to assess accurately the stage of the tumour. Favourable lesions are those which are small, exophytic, and mobile on the surrounding tissues. A transphincteric approach has been advocated for these tumours, but this seems unnecessarily destructive.The present series consists of 18 highly selected patients who were treated by transanal local removal. There have been two recurrences, one of which has been treated by abdominoperineal resection and the other by further local excision. All of these patients were diagnosed clinically as suffering from carcinoma before operation. Patients who had a preoperative diagnosis of carcinoma and were later found to have benign adenomas, and patients who were diagnosed as benign and later found to have histological malignancy, have been excluded.
BLEEDING OESOPHAGEAL VARICES
Authors: STEPHEN MICHAEL , LITTLE J. MILES 
Published: January 2008

At the Royal Prince Alfred Hospital, most patients with bleeding varices have been poor‐risk alcoholics. A high proportion were receiving a State pension. The early mortality due to bleeding varices was 53%. This figure comprised a 60% mortality following conservative management and 40% after urgent shunt. All patients having urgent operations which were not portal decompression died. No patient who had an elective shunt died. In a mean follow‐up period of 15.4 months, a further 14% of survivors died.No form of conservative management appeared to have much effect on the natural history of the bleeding. A blood replacement of more than five litres indicated that spontaneous cessation of haemorrhage was unlikely. Shunt operations usually controlled haemorrhage, but hepatorenal failure was common after the urgent shunts. The cost of operation was greater than that of conservative management, but in neither case was it considered excessive.
COLORECTAL CARCINOMA IN HONG KONG
Authors: WONG JOHN , ONG G. B. 
Published: January 2008

The clinical and pathological features of colorectal carcinoma occurring in 470 Chinese patients in Hong Kong are reported. There was a preponderance of advanced stages of the disease in spite of the presence of a large number of well‐differentiated lesions. Polyposis coli was the predisposing cause in 1% of our patients, and none of them had ulcerative colitis.The clinical features of our patients on presentation were generally similar to those exhibited by Caucasians. An abdominal mass was palpable in about half of patients with colonic lesions, and virtually all rectal cancers could be felt by rectal examination. Almost a quarter of our patients presented with complications. In 2% of our patients the initial diagnosis was acute appendicitis.A high resection rate was achieved, but many radical resections turned out to be only palliative. Our operative mortality was 8.3%, although for social reasons, the “in‐hospital” mortality was 19.2%. The corrected five‐year survival rate was 42.7% when curative resection was attempted.
GASTROINTESTINAL COMPLICATIONS FOLLOWING RENAL TRANSPLANTATION
Authors: MEECH P. R. , HARDIE I. R. , HARTLEY L. C. J. , STRONG R. W. , A.‐CLUNIE G. J. 
Published: January 2008

Gastrointestinal complications occur'red in 19 of 290 recipients (6.6%) of the 325 cadaveric renal allografts undertaken between September 1969 and December 1978. The mortality was 42.1%. Upper gastrointestinal complications, principally haemorrhage, occurred in 12 patients (4.1%), 11 of whom were males, usually within four months of transplantation, and often associated with acute rejection and its treatment. Surgery was required in five patients. The overall mortality was 16.7%. Colonic complications occurred in five patients (1.7%), four of whom died, the absence of specific signs having led to a significant delay in diagnosis. One patient died from abdominal vascular disease, and one from carcinoma of the gallbladder.To decrease the high morbidity and mortality, both medical and appropriate surgical prophylaxis for peptic ulceration and diverticular disease are necessary, as is an awareness of the transplant recipient's propensity to develop a gastrointestinal complication at any time, up to years after transplantation. Early recognition and treatment of such complications are essential.
PRIMARY SARCOMAS OF THE JAW
Authors: LAM K. H. , WONG J. , ONG. S. T. K. LlM AND G. B. 
Published: January 2008

Nine cases of primary sarcoma of the jaw seen over a period of 14 years are presented. They consisted of four osteosarcomas, three fibrosarcomas, one myxosarcoma and one Ewing's sarcoma. The treatment of choice for osteosarcomas of the mandible is hemimandibulec‐tomy with disarticulation at the temporomandibular joint. Bone graft reconstruction from the iliac crest should be done at a second stage. Palliative maxillectomy for extensive fibrosarcoma of the maxilla served to relieve one patient of local symptoms for more than a year. Myxosarcoma, a variant of fibrosarcoma, and Ewing's sarcoma of the jaw, are very rare conditions, and since these lesions are usually very extensive radiotherapy is the treatmentof choice.
SIR DOUGLAS SHIELDS (1876–1952) A FORGOTTEN AUSTRALIAN SURGEON*
Authors: Murphy LeonardJ. T. 
Published: January 2008

The remarkable and colourful career of sir douglas shields of melbourne is unparalleled among australian surgeons of his generation: murray morton describes it as a romance.He graduated in 1897 and was, in turn, a country general practitioner, the principal medical officer of an overcrowded plague‐ship bringing home soldiers from the boer war, senior surgeon of st vincent's hospital. Melbourne then, in london, surgeon‐in‐chief of his own hospital converted to the ‘hospital for wounded officers’ with promotion to the ranks of brigadier‐general and rear‐admiral, then knighted and, finally, a consultant surgeon with private hospitals in park lane and in cannes, and with patients largely drawn from the aristocracy, the rich and the famous.His name is now virtually forgotten in australia but, for many years after he left melbourne in 1912, stories used to be told about his career and experiences, many of which had little basis in fact, and even the two brief biographical accounts of his career by murray morton and ormond smith contradict each other.This paper will, i hope, help to preserve the memory of sir douglas shields whom ormond smith considered ‘one of the brightest ornaments of the medical school of the melbourne university’.
FINE CATHETER PERITONEAL CYTOLOGY FOR THE ACUTE ABDOMEN: A RANDOMIZED, CONTROLLED TRIAL
Authors: Stewart Richard J. , Gupta Raj K. , Purdie Gordon L. , Holloway Linda J. , Isbister William H. 
Published: January 2008

A randomized. controlled clinical trial, of sequential design. was Undertaken to determine whether line catheter aspiration cytology of the peritoneal cavity, using the percentage of neutrophils in the sample as the main test marker. reduces errors about urgent laparotomy in patients admitted to a surgical unit with acute abdominal pain.One hundred and forty‐four patients with acute abdominal pain were studied. Of these, 26 were excluded because the test was unlikely to be useful and 20 did not consent. Conventional clinical assessment was undertaken and then the subjects were randomly allocated to have a peritoneal cytology test or not. After the test result was made available, the surgeon(s) decided whether to operate or continue conservative treatment. The correct decision was later ascertained by a blinded clinical referee.With the entry of the 98th patient the difference between the groups achieved the 5% significance level. The groups were well‐matched in regard to demographic and other variables. The decison about urgent laparotomy was incorrect in only 8.2% of the test patients, compared with 28.6% of the others.It is concluded that fine catheter aspiration cytology of the peritoneal cavity is likely to reduce the numbers of unnecessary or delayed laparotomies when used in most patients admitted with acute abdominal pain.
CHANGES IN THE BLOOD BIOCHEMISTRY FOLLOWING EXPERIMENTAL FLAP ISCHAEMIA
Authors: Knight Kenneth R. , Gumley Graham J. , Rogers Ian W. , O'Brien Bernard McC. 
Published: January 2008

The purpose of this study was to elucidate tissue changes occurring within an ischaemic flap by monitoring the blood biochemistry, and to evaluate these changes in relation to ultimate flap viability.A rabbit epigastric free flap was made ischaemic for 4 days at 6° C, then revascularized by anastomosis of its femoral artery and vein. An identical free flap immediately revascularized in another group of rabbits served as a control. The viability of the free flap, as well as various biochemical parameters studied by drawing blood from a catheter in the ear vein, were observed daily.Immediately after the revascularization of ischaemic flaps, there was a 16‐fold increase in the plasma levels of creatine kinase (CK) and a smaller but significant 1.5‐fold to 2.0‐fold increase in lactate dehydrogenase (LDH) and aspartate aminotransferase (AST). In flaps which ultimately failed by 7 days post‐ischaemia, the plasma levels of CK, LDH and AST peaked at day 2 post‐ischaemia at 68, 13 and 8 times normal respectively, whereas in flaps which survived, the levels of these enzymes recovered to normal by day 3 post‐ischaemia. These enzymic changes are probably due to a combination of ischaemic changes in the flap vasculature, ischaemic changes in the flap muscle, and inflammatory changes in the surrounding abdominal tissue.The plasma levels of CK at any time post‐ischaemia, and particularly in the first 24 h, were significantly higher in ischaemic flaps which failed compared with those which survived. This parameter is therefore proposed as a possible means of predicting potential flap failure after ischaemic insult, in time to make appropriate surgical intervention.
PLASTIC SURGERY OF THE TRUNK – REDUCING BLOOD LOSS
Authors: Rigg Bruce M. 
Published: January 2008

SummaryA total of 178 patients has been reviewed who underwent major plastic surgery over a 6‐year period. This series compares well with other similar series.1–3 No transfusions were required and the average blood loss was estimated at 150cm3. Dilute epinephrine infiltration and coagulation cautery dissection effectively controls and reduces blood loss in major plastic surgery of the trunk.
MANAGEMENT OF GALLSTONE PANCREATITIS
Authors: Fielding G. A. , Mok F. , Wilson C. , Imrie C. W. , CARTER D. C. 
Published: January 2008

The clinical course of 143 patients with gallstone pancreatitis is reviewed. Thirty‐one patients (22%) had three or more positive prognostic factors on admission and 24 (77%) of these had a complicated course. Thirteen patients died, giving an overall mortality rate of 9%.Patients were divided into three groups on the basis of performance and liming of surgery. In group I (n= 56), surgery was undertaken during the first admission with acute pancreatitis; eight of these patients had a complicated course and three died. In group 2 (n= 40), biliary surgery was deferred to a subsequent admission: none of these patients died but 10 experienced further attacks of pancreatitis white awaiting reoperation. Group 3 patients (n= 47) did not undergo surgery; nine patients were diagnosed as having gallstone pancreatitis for the first lime at autopsy, five refused operation, seven were lost to follow‐up, six were deal! with by endoscopic sphincterotomy, and in 20 cases surgery was not considered appropriate because of general debility or advanced age.Despite the zero mortality rate in group 2, it is advocated that biliary surgery be carried out during the index hospital admission. Endoscopic sphincterotomy can now be considered as an alternative to cholecystectomy and duct clearance in the elderly and unfit, and may be used as a preliminary manoeuvre when severe acute pancreatitis fails to settle promptly on conservative management.