bluuebunny/crossref_metadata_2025_split huggingface dataset:
ES08 DIAGNOSTIC AND THERAPEUTIC STRATEGIES OF ADRENOCORTICAL CARCINOMA‐A 3‐INSTITUTION EXPERIENCE
Authors: Imisairi A. H. , Hisham A.N. , Lennard T.W.J. , Bliss R.D. , Harrison B.J. , Perini M. 
Published: April 2007

Objective  This paper reviews the diagnostic, therapeutic strategies and outcomes of ADCC in 3 Institutions between Newcastle and Sheffield in United Kingdom and Putrajaya, Malaysia.Patients and Methods  A 10‐year retrospective analysis of proven cases of ADCC was collected from January 1997 to December 2006. The patients’ demographic data, clinical manifestation, site and size of the tumour were analysed. The record of metastasis, and therapeutic modality and outcomes were evaluated.Results  A total of 22 cases of ADCC were documented in United Kingdom with 11 cases in each respective center. 16 cases were reviewed from Putrajaya. There was no gender preponderance and age significance. Cushing’s Syndrome was the most common clinical manifestation (36.4%) in United Kingdom and (37.5%) in Putrajaya. The mean size of the ADCC was 9.3 cm (5–15 cm) in Newcastle and 9.8 cm (6–15 cm) in Sheffield as compared to 15.7 cm (5–25 cm) in Putrajaya. There were 12(75%) of patients in Putrajaya were diagnosed with Stage IV disease upon presentation whilst only 3(27.3%) and 5(45.4%) patients had metastasis noted in Newcastle and Sheffield respectively. Of note, 7(63.3%) patients in Sheffield were offered radical adrenalectomy. Our data revealed that the 2 years survival of patients who had radical approach in Sheffield has the highest rate of survival of 8(72.7%) as compared to 5(45.4%) in Newcastle and 2(12.5%) in Putrajaya.Conclusions  Surgical removal remains the only form of curative therapy and hope of prolonged survival. The poorer prognosis of patients in Putrajaya may be attributed to the advanced stage of the disease.
GS01 INGUINAL HERNIORRHAPHY USING KUGEL PATCH
Authors: Ali A. , Childs P. , Sanfilippo F. 
Published: April 2007

Purpose  Inguinal hernia repair is one of the most frequently performed operations in general surgical practice. A variety of techniques have been used in the past with different results. The aim of the present study is to report our experience of inguinal hernia repair using the Kugel patch and to measure the frequency of postoperative recurrence and chronic groin pain.Methodology  Data were recorded prospectively from a series of 333 inguinal hernia repairs performed between January 2004 to December 2006 using the Kugel patch technique. Wound infection, seroma, haematoma urinary retention, 6‐month recurrence and chronic groin pain were the outcome measures.Results  The Kugel patch hernia repairs were performed in 284 patients during the 3‐year period. There were no recurrences or chronic groin pain within 6 months of the 333 repairs. There was only one reported wound infection. The average operating time for bilateral hernia repair was 40.5 minutes (SD 8.8). Recurrent hernias took an average of 26 minutes (SD6.2) to repair whilst unilateral hernias took an average of 23 minutes (SD 6.8). 5 (1.8%) of the 284 patients had urinary retention. The average operating time for 136 direct procedures was 27 minutes compared with 25 minutes for the 148 indirect procedures (p = 0.096, t‐test).Conclusion  In this prospective series the Kugel hernia repair is associated with no post hernia repair groin pain and no recurrence within 6 months of the procedure. It is inexpensive compared with laparoscopic repair, and allows the surgeon to cover all potential defects with one piece of mesh.
GS11P LAPAROSCOPIC ANTERIOR RECTOPEXY: CURES RECTAL PROLAPSE AND IMPROVES PREOP CONSTIPATION WITHOUT INDUCING NEW‐ONSET CONSTIPATION
Authors: Collinson R. J. , Boons P. , Cunningham C. , Lindsey I. 
Published: April 2007

Purpose  Abdominal posterior rectopexy for rectal prolapse produces the lowest recurrence rates. However, 50% are troubled by severe postoperative constipation. Resection mitigates this dysfunction but involves the risks of an anastomosis. We aimed to evaluate functional results with laparoscopic anterior rectopexy, a novel technique designed to avoid rectal denervation and constipation.Methodology  Between January 2004 and December 2006 consecutive patients with rectal prolapse were offered undergoing laparoscopic anterior rectopexy. Patients were assessed preoperatively, at 3 and 12 months clinically and functionally (Wexner constipation and Faecal Incontinence Severity Index scores).Results  63 consecutive patients underwent laparoscopic anterior rectopexy. In this period no patient underwent a perineal procedure. Follow‐up was for a median of 18 months (range 3–36 months). Minor complications occurred in 11%. There was one recurrence (2%), one conversion and no 30‐day mortality. Median operating time (144 mins) and length of stay (3 days) shortened with experience. Constipation improved in 78% and median constipation scores fell from 8 to 3 (p < 0.0001). In no patients was severe new‐onset constipation induced. Continence improved in 90% and median incontinence scores fell from 32 to 0 (p < 0.0001).Conclusion  Laparoscopic anterior rectopexy cures rectal prolapse and corrects incontinence equivalent to a posterior rectopexy. However uniquely it improves associated constipation without inducing new severe constipation, with the morbidity profile of a minimally invasive procedure. These qualities enable it to become the new gold standard for rectal prolapse.
GS12P MANAGEMENT OF UPPER GASTROINTESTINAL HAEMORRHAGE IN A DISTRICT HOSPITAL
Authors: Dayoub I. , El‐Hasani S. , Kasem A. M. , Kamal T. , Muniyra H. , Chandra N. N. 
Published: April 2007

Background  This study was conducted to assess the management of acute upper gastrointestinal bleeding in a district hospital and to compare these results with national guidelines and the published literature.Materials And Methods  This prospective and retrospective study included 112 patients, mean age 66 years, who presented with acute upper gastrointestinal bleeding between July 2004 and February 2005. All patients were assigned a Rockall risk assessment score.Results  The surgical on‐call teams managed all the patients according to an agreed protocol. 49 patients had a Rockall score > or = 4. Endoscopy was performed in all patients, with 60% accomplished within the first 24 hours. The most common cause found was peptic ulcer (30%). Therapeutic endoscopy was undertaken in 10 patients (9%) with a success rate of 70%. Open surgery was performed in 3 patients. One patient died after having surgery and the Rockall score was >5. Of the patients admitted with acute upper gastrointestinal bleeding, 90.2% were discharged without complication. 11 patients died (9.8%) and all of them from the high risk group with Rockall scores >5. Their mean hospital stay was 17.8 days (range, 2–43 days).Conclusion  High‐standard results in acute upper gastrointestinal bleeding can be achieved in a district hospital. The management, including the use of the operating theatre facilities with operative and anaesthetic support, was safe and efficient. A 24‐hour‐a‐day endoscopy service is important to achieve early diagnosis and to plan management. A protocol and early endoscopy improve clinical outcome and reduce mortality, which occurred mostly among elderly patients with high risk scores. It is advisable to introduce the Rockall scoring system in practice.
GS15P IS THERE A BETTER WAY TO DETERMINE PRIVATE SURGICAL FEES IN NEW ZEALAND?
Authors: Windsor J. A. , Brown P. , Law M. 
Published: April 2007

Purpose  In New Zealand, surgeons working in the private sector are reimbursed on a fee‐for‐service basis. Due to concerns that a truly competitive market does not exist, other countries have adopted a Relative Value Scale (RVS) to help determine a fair relative rate of reimbursements. No such scale exists in NZ for surgeons, but does so for anaesthetists.Methodology  This study compares reimbursements to surgeons and anaesthetists from private insurers, other than Southern Cross, using data from 3186 procedures performed between 1996 and 2002. We calculate an implicit hourly rate of reimbursement and then compare the level of reimbursements between procedures and the variance of reimbursements within a procedure for surgeons and anaesthetists.Results  The results demonstrate significantly greater variations in average reimbursements between procedures for surgeons than for anaesthetists. Furthermore, the variability of reimbursements is greater for reimbursements to surgeons within specific procedures, especially for those more recently introduced.Conclusions  While the results do not necessarily imply that surgical reimbursements are inconsistent with underlying market rates, the results are consistent with the hypothesis that anaesthetist’s fees show greater stability because of the existence of a RVS. We conclude by suggesting that a RVS for determining private surgical fees should be given serious consideration in New Zealand.
GS20P SINGLE‐CENTRE EXPERIENCE WITH MESH REPAIR OF ABDOMINAL HERNIA IN CAPD PATIENTS
Authors: Johns E. M. , Poole G. 
Published: April 2007

Purpose  Patients with end stage renal failure on continuous ambulatory peritoneal dialysis (CAPD) represent a potentially infected environment in which to use mesh for the repair of abdominal hernia. We present a review of our experience with these patients.Methodology  Retrospective review of all mesh repairs of abdominal hernia in CAPD patients performed by the senior author from 1997–2006.Results  46 patients had 54 hernias repaired (25 umbilical, 18 inguinal, 9 incisional and 2 epigastric) using polypropylene mesh. 13 patients had simultaneous Tenckhoff catheter insertion. Median age was 63 years (range 22–85) and 22 were diabetic. CAPD was commenced or recommenced a median of 2 weeks after the repair (range 0 days–6 weeks). 6 short‐term complications were recorded. 2 patients were treated for culture negative CAPD peritonitis within the first week after repair. 2 patients had localised wound bleeding and 1 patient was admitted with a wound infection. All were treated conservatively and no patient required mesh removal. 1 patient developed CAPD peritonitis at one month post‐operation and required Tenckhoff removal, subsequent laparotomy and conversion to haemodialysis. At a median follow‐up of 30 months (range 3–87) 29 patients were still alive and 2 patients were lost to follow‐up. There were 4 documented recurrences and 1 patient had been converted to haemodialysis because of hernia recurrence.Conclusions  Mesh can be safely used to repair most hernias in CAPD patients. The results are comparable to those in healthy patients and mesh removal due to infection is extremely rare.
GS21P THE USE OF ADJUVANT THERAPIES IN COLORECTAL CANCER AT A REGIONAL CENTRE
Authors: Morrissey D. , Yang S. M. , Franz R. 
Published: April 2007

Purpose  The use of adjuvant therapies in colorectal carcinoma is becoming more common. However, it can be logistically difficult for patients of regional hospitals to have access to such treatments. Our aim was to document the proportion of regional patients with colorectal cancer who received chemotherapy and/or radiotherapy.Method  An audit of all patients treated for colorectal cancer at Toowoomba Base Hospital between 1 January 1990 and 1 April 2006 was undertaken. Chemotherapy use, radiotherapy use, anatomical location and histological grade of the cancers were examined.Findings  Of the 225 patients who had surgery for Dukes B colonic carcinomas, 22.7% were given chemotherapy. This rate increased to 59.6% for Dukes C colon cancers. 141 rectal cancers were curatively excised during the prescribed period. 39 of these patients received radiotherapy (27.7%). Of these, only 2 (5.13%) had pre‐operative radiotherapy. 19 patients had rectal cancers which were considered non resectable and of these, 5 (26.3%) were treated with radiotherapy.Conclusion  Despite the paucity of high level evidence showing a benefit in using adjuvant therapy in node negative colon cancers, a relatively large proportion of our regional patients with Dukes B adenocarcinomas were given chemotherapy. The rate of such therapy for Dukes C cancers was comparable to other studies. Fewer than expected patients with rectal adenocarcinomas had radiotherapy. Of those who did receive this, only a very small proportion received pre‐operative radiotherapy. It may be that the lower than expected rates of radiotherapy were due to this service being located about 130 km from Toowoomba Hospital.
GS23P PAEDIATRIC SURGERY PERFORMED BY GENERAL SURGEONS IN A PROVINCIAL NEW ZEALAND (NZ) HOSPITAL
Authors: Peng S. L. , Fancourt M. , Gilkison W. , Kyle S. , Mosquera D. 
Published: April 2007

Purpose  To perform an audit of paediatric surgical patients in a provincial general surgical unit.Methodology  Data was prospectively recorded using a standardized proforma on all children aged up to 15 yrs, seen between 11th December 2005 and 11th December 2006.Results  There were 209 admissions (194 children), median age 8 yrs (6 wks–15 yrs) with 153 (73%) acutes. 37 children (18%) were under 2 yrs. Male : female ratio was 3 : 2. Procedures (n = 119) were appendicectomy (35), inguinal herniotomy (30), skin procedures (29), endoscopy (10), testicular (10) and others (5). The commonest acute and elective operations were appendicectomy and inguinal herniotomy respectively. 51% of operations were acute.There were 10 tertiary hospital transfers (5%) for burns (4), pyloric stenosis (3), intussusseption (1), neonatal inguinal hernia (1) and pyoderma gangrenosum (1). Median age of transfers was 11 months (6 wks–14 yrs).Complications were wound infection (1), post‐operative ileus (2) and infarcted ovary (1).Conclusion  There are increasing moves towards centralization in paediatric surgery.1 With only 4 paediatric tertiary centres in NZ, many general surgeons routinely perform paediatric surgery. A large number of children presented to our surgical department. Around half of these children required surgery and half of operations were acute. There is still a significant need for general paediatric surgery in the provinces and hence close collaboration with specialist paediatric surgeons.
GS24P COMPLIANCE WITH SURGICAL ANTIBIOTIC PROPHYLAXIS GUIDELINES IN VICTORIA, AUSTRALIA
Authors: Russo P. L. , Bennett N. J. , Boardman C. J. , Richards M. J. , Bull A. L. 
Published: April 2007

Purpose  To assess compliance with national and international guidelines for surgical antibiotic prophylaxis in Victorian public hospitals and observe trends over time when results were reported back to hospitals.Methodology  Data on surgical antibiotic prophylaxis (drug choice, time of administration of first dose and duration) were collected as part of a surveillance system for hospital‐acquired infections from April 2003 until September 2006. Results (own hospital and aggregate) were reported to hospitals on a six‐monthly basis during this time.Results  Compliance with guidelines is best for cardiac and orthopaedic surgery, less so for other types of surgery. Improvements have occurred over the time period following commencement of reporting, mainly in compliance with choice of antibiotics.Conclusion  Feedback of results appears to have led to a decrease in the proportion of procedures where antibiotic prophylaxis is not considered to comply with guidelines, particularly for drug choice. There is still room for improvement, particularly with timing of administration and documentation of when antibiotics are administered. The VICNISS coordinating centre will continue to feed back results to hospitals on compliance with surgical antibiotic prophylaxis recommendations and to encourage both documentation and compliance.
GS28P LAPAROSCOPIC CHOLECYSTECTOMY FOR OBESE PATIENTS
Authors: Li S. W. , Moss D. 
Published: April 2007

Background  Laparoscopic surgery is often perceived to be more difficult for obese patients. Middlemore Hospital has unique patient population with high prevalence of obesity. This is a pilot study to compare the outcome of obese and non‐obese patients who had laparoscopic cholecystectomy in our institution. Our hypothesis is that obese patients do not suffer more adverse postoperative outcome.Methods  We reviewed all patients undergoing acute and elective cholecystectomy from January 2004 to December 2006, 100 obese patients were identified. The control group consists of 100 non‐obese patients matched for age, sex and type of admission. Outcome assessed includes length of recovery period, complication and conversion rate.Results  Over the three year period there were 1400 cholecystectomies, of which 96% were commenced laparoscopically. Overall conversion rate was 3.8%. The obese group has increased rate of wound complication (10% vs 2%, p = 0.037) and conversion rate (8% vs 3.5%, p = 0.28). The two study groups have similar median length of postoperative stay of 4 days.Conclusion  This confirms our hypothesis that it is safe for obese patients to have laparoscopic cholecystectomy. However there is increased risk of conversion and wound complication.
GS04 CAN EVIDENCE BASED PROFORMA’S AND DEPARTMENTAL AUDIT IMPROVE THE MANAGEMENT OF ACUTE PANCREATITIS?
Authors: Lienert A. R. , Connnor S. J. , Bagshaw P. F. 
Published: April 2007

Purpose  To assess whether evidence based proforma’s and departmental audit can improve the management of patients with acute pancreatitis as compared to published international guidelines.Methodology  From June 2005 all patients admitted with acute pancreatitis were required to have an evidence based proforma prospectively completed. In March 2006 an interim analysis was performed and presented to the department of General Surgery highlighting areas which deviated from published guidelines. Key clinical indicators were analysed pre and post presentation.Results  Two hundred and eighty one patients were admitted with acute pancreatitis, 168 (60%) of whom were analysed in the interim analysis. The median (range) age was 59 (12–96) years and the aetiology was gallstones in 149/281 (53%) patients. 140/281 (50%) patients had predicted severe pancreatitis, but there was no difference pre and post departmental presentation (85/168 (51%) vs. 56/113 (50%), p = 0.865). On univariate analysis following the departmental presentation there was a significant reduction in the number of CT scans performed (76/168 (45%) vs. 30/113 (27%), p = 0.002), an increase in the number of patients undergoing definitive treatment for mild biliary pancreatitis (36/65 (55%) vs. 35/43 (81%), p = 0.006) and a reduction in mortality (9/168 (5%) vs. 1/113 (1%), p = 0.047). Multivariate analysis confirmed departmental presentation as independent prognostic factor in reducing the number of CT scans (p < 0.001) and increasing definitive treatment of mild biliary pancreatitis (p = 0.02).Conclusions  For Audit to change practice evidence based protocols alone are not sufficient. Feedback to clinicians would appear to be a powerful motivator of change.
GS06 A PROSPECTIVE NON‐RANDOMIZED STUDY OF 737 CONSECUTIVE CASES OF LAPAROSCOPIC INGUINAL/FEMORAL HERNIA REPAIR: SUPERIORITY OF THE LAPAROSCOPIC EXTRAPERITONEAL APPROACH BY A SPECIALIST HERNIOLOGIST
Authors: Tran H. M. 
Published: April 2007

Introduction  Laparoscopic hernia repair remains controversial. This study aims to assess its safety and efficacy by a specialist herniologist.Materials and Methods  A prospective assessment of all patients referred from 1st January 2002 to 31st December 2006 for laparoscopic extra‐peritoneal inguinal/femoral hernia repair was undertaken. Polypropylene mesh was used prior to June 2004 and light weight mesh after. Patients were followed up for 5 years.Results  There were 737 hernias performed in 525 patients (including 34 recurrent and 78 Workers Compensation cases) with a median age of 51 years. Mean operation time was 48 minutes for unilateral and 65 minutes for bilateral. Mean follow‐up was 3 years with one recurrence. Conversion to open operation occurred in 4 patients. Day surgery was achieved in 92% of cases with most of those staying overnight for social reasons. There was no mortality. Morbidity was low: 2 cases of urinary retention, 1 case of minor urethral bleeding and 3 cases of pneumomediastinum. Return to work/resumption of full activities occurred at a mean of 14 days. Significant chronic pain occurred in 4 patients (1 with light weight mesh) and all settled with Carbamazepine or Neurontin.Conclusions  Laparoscopic inguinal/femoral hernia repair can safely be performed as day cases with zero mortality, minimal morbidity, early resumption of physical activities and low recurrence. The use of light weight mesh resulted in fewer cases of chronic pain. Preoperative catheterization seemed to reduce incidence of urinary retention. Careful preoperative counseling achieved identical resumption of physical activities/work with Workers’ Compensation cases.
GS09 AUTOPSY IN GENERAL SURGERY: A COMPARISON OF PRACTICE AND OPINION
Authors: Stiven P. N. , Frampton C. , Lewis D. R. 
Published: April 2007

Objective  To examine current practice regarding autopsy requests and assess consultant opinion in a general surgical department.Methods  100 patient deaths in a general surgical department, over a 2 year period, were randomly selected. A brief summary of each admission was distributed to 13 general surgeons who were asked to comment whether; cases should have been discussed with the coroner, a coroner’s autopsy should have been performed, a hospital post mortem should have been performed and whether it would be appropriate to complete a death certificate without post mortem. Surgeon responses were compared with actual outcomes.Results  The majority of patients were elderly (median age 79 yrs, 49% > 80 yrs), admitted acutely (92%) and did not undergo an operation (73%). Patients who had undergone recent operation were more likely to be referred to the coroner (p < 0.001) and more likely to undergo coroners autopsy (p = 0.011). Older patients and those admitted from a rest home were less likely to be referred to the coroner (p < 0.001 & 0.02 respectively) or undergo coroners autopsy (p = 0.002). The survey predicted more referrals to the coroner (p = 0.001), more hospital autopsies (p < 0.001), and that the treating doctor would complete the certificate of death less often than actually happened (p = 0.004).Conclusions  General surgeons consider autopsy to be necessary more often than current practice in our institution. The decline in autopsy rates may compromise the education of surgeons and trainees.
HS10 FLAP COVERAGE IN UPPER LIMB INJURIES
Authors: Teoh L. C. 
Published: April 2007

The severely of skin loss and the options of resurfacing is determined by taking into account the following factors. 1) The size & location of the defect, 2) The depth of the defect and the quality of the tissue bed, 3) The extent of exposed vital structures, 4) The associated bone and other tissues injuries, 5) The availability of donor skin flap.The size of the defect is the most important factor in choosing a resurfacing option. The size can be categorized into small, medium and large. A small defect is one that is less than 5 cm2 in size, a medium defect is between 5 to 15 cm2, and a large defect is greater than 15 cm2.Local flaps are usually sufficient to cover small defects <5 cm2. These are advancement flaps or rotation and transposition flaps.Regional flaps are indicated to resurface these medium‐sized defects 5 to 15 cm2. The donor is within the same region of the hand, from one of the digits or from dorsum and palmar surfaces of the hand. It is usually based on vascular or NV pedicles.Large defects >15 cm2 will need larger flaps for coverage. These large flaps are pedicled distant flaps and free flaps. In these severe injuries, there is usually associated bone and soft tissues injuries. These injuries can be reconstructed as a single stage combined reconstruction or multi‐staged reconstructions. The resurfacing should always be given priority.