bluuebunny/crossref_metadata_2025_split huggingface dataset:
VALIDATION OF A PROGNOSTIC INDEX IN BREAST CANCER
Authors: Alexander A. I. , Mercer R. J. , Muir I. M. , Bennett R. C. , Rennie G. C. 
Published: January 2008

The validation of a prognostic index for patients with primary breast cancer is described. The actual survival data in a group of 383 patients was compared with expected survival predicted by an index based on axillary lymph node status, oestrogen receptor, progesterone receptor and age. There was no significant difference between actual and predicted deaths for five ranges of index value at 2 years and for the three highest ranges of index value at 5 years. However, in the two lowest ranges, the index significantly underpredicted deaths at 5 years.The cox proportional hazards model was used to determine if there was any significantly better combination of coefficients and covariates to predict survival in the test group. The original index—1 = n + e+p+a, where n = 0 if no nodes are involved, 13 if one to three nodes are involved, and 31 if more than three nodes are involved; e = 15 if oestrogen receptor value is less than 10 fmol/mg cytosol protein and 0 otherwise; p = 12.5 if progesterone receptor value is less than 10 fmol/mg cytosol protein and 0 otherwise; and a = number of years over age 65—was as good as any competing model in ranking survival prospects in the test group. However, it was a less sensitive predictor in this group than in the original set of patients.A second index based on tumour size, hormone receptor status and age, for use when lymph node status was unavailable, was tested by the same method and validated.It was concluded that both indices remain valid when applied to a different group of patients, further confirming their value in patient management.
TREATMENT OF ADVANCED AND INACCESSIBLE SARCOMAS WITH CONTINUOUS INTRA‐ARTERIAL CHEMOTHERAPY PRIOR TO DEFINITIVE SURGERY OR RADIOTHERAPY—A POSSIBLE ALTERNATIVE TO AMPUTATION OR DISABLING RADICAL SURGERY
Authors: Stephens FrederickO. , Stevens MichaelM. , Mccarthy StanleyW. , Johnson Neva , Packham NicholasA. , Ritchie JamesD. 
Published: January 2008

Four patients with advanced and inaccessible soft tissue sarcomas were treated with a regimen of intra‐arterial chemotherapy followed by radiotherapy and/or surgical excision. Two of the patients had advanced sarcomas in the buttock and thigh regions which would otherwise have required hindquarter amputation in one case or disarticulation of the hip in the other case.These sarcomas responded significantly to intra‐arterial chemotherapy to the extent that subsequent local surgery was effective in eradicating the residual tumours. No viable tumour cells were found in the resected specimens. In both patients amputation was avoided and local tumour eradication was achieved.In the other two patients, advanced and non‐resectable sarcomas in the head were first treated with a similar regimen of intra‐arterial chemotherapy. In both cases the tumours regressed in size prior to administration of local radiotherapy. After completion of chemotherapy and radiotherapy no viable tumour cells were detected in either lesion. In one case (originally a very extensive sarcoma of the jaw in a 5 year old child) a residual lump was resected but no viable tumour was detected in the resected specimen.These four patients represent our total experience with this plan of management. All responded well and there has been no evidence of local disease recurrence in any of the four patients.One patient (case 2) did develop pulmonary and bone metastases from which she died 2 years later but the other three patients remain well with no evidence of residual disease, 11 years, 4 years and 20 months after presentation.
RESCREENING OF A GROUP AT HIGH RISK FOR COLORECTAL NEOPLASIA USING IMMUNOCHEMICAL TESTS FOR FAECAL OCCULT BLOOD
Authors: Hunter Ronald , Williams J. Anthony R. , Thomas David W. , Coles Margaret E. , Walsh Robert , Leong Anthony S. Y. , Copland Joy G. 
Published: January 2008

The results of a screening programme for colorectal neoplasia in a high risk group using an immunochemical test for blood has been reported recently. This test is known as the faecal human haemoglobin (FHH) test. This paper reports the results of rescreening this group after an interval of 1–2 years. The FHH test was compared with a paper disc method.All individuals with positive tests were investigated and those with negative tests were offered investigation. The results confirm the value of the FHH test in screening a high risk group: 19 individuals in 1153 participants were found to have a significant neoplasm (1.6%). The predictive value of the test for a significant neoplasm was 42%. A false negative rate of 2.6% was found, all lesions being benign. It appears to be more reliable than the paper disc method but the differences do not reach statistical significance.The FHH test is recommended for screening the general population over the age of 40 years, with rescreening annually.
SELECTIVE USE OF HEPARIN IN AORTIC SURGERY
Authors: Burnett J. , Payne J. , Gray‐Weale A. C. , Lusby R. J. 
Published: January 2008

The incidence of distal ischaemia following aortic reconstruction may be as high as 25%, despite the use of systemic heparin. As anticoagulation may be associated with excessive operative blood loss, a retrospective study was performed to assess the prevalence of these problems, in a consecutive series, during a 30‐month period. Evaluation of reconstruction was possible in 161 patients with aneurysm and 38 patients with occlusive disease. The incidence of vessel occlusion was 21% in the occlusive and 4% in the aneurysm group (P < 0.05). Four of seven patients who had major vessel occlusion had serious complications. and there were two resultant deaths. These problems occurred despite the administration of heparin. Blood loss and operating time were quantitated in the patients who had resection for aortic aneurysm. Both were significantly longer in patients who received heparin (P < 0.05) and the differences were maintained when patients were stratified according to increments in dose or operating time, and according to whether woven tube or bifurcation grafts were performed.It was concluded that aneurysm surgery, in the absence of distal occlusive disease, could be safely performed without the use of systemic heparin, but surgery for occlusive disease still requires heparinization.
PRIMARY MALIGNANT FIBROUS HISTIOCYTOMA OF THE RETROPERITONEUM
Authors: Faragher I. G. , Bennett T. M. , Cass A. J. 
Published: January 2008

A 38 year old woman presenting with minimal digestive symptoms was found on ultrasound and computerized tomography scanning to have a large, solid, uniform mass arising in the region of the right adrenal gland. Preoperative investigations indicated a non‐functioning tumour. At operation a well‐circumscribed, ovoid tumour was removed and found subsequently to be a malignant fibrous histiocytoma arising adjacent to the right adrenal gland.It is believed that sarcomas arising in the retroperitoneum should be included in the differential diagnosis of masses presumed to be adrenal tumours on scanning. The limitations of computerized tomography scanning in distinguishing between benign and malignant tumours and between adrenal and juxta‐adrenal masses should be recognized. Tumour size is the best indicator of malignancy and it is recommended that non‐functioning tumours greater than 5 cm in diameter be presumed malignant until proven otherwise histologically. Surgical removal of all non‐functioning retroperitoneal masses greater than 5 cm in diameter is therefore recommended.
MEDIAN NERVE COMPRESSION IN THE PALM OF THE HAND BY AN ANOMALOUSLY ENLARGED ULNAR ARTERY
Authors: Hankey Graeme J. 
Published: January 2008

Median nerve compression in the carpal tunnel by a thrombosed persistent median artery and a large aberrant artery substituting for the radial artery has been described but there have been no reports of median nerve compression in the palm of the hand by an anomalously enlarged ulnar artery.A 46 year old man is described who presented with clinical and electrophysiological features consistent with a median neuropathy at the wrist but surgical exploration revealed median nerve compression in the palm of the hand by an anomalously enlarged palmar branch of the ulnar artery. This case highlights another treatable muse of median nerve compression and illustrates that symptoms suggestive of carpal tunnel syndrome may be produced by median nerve compression in the palm of the hand.
FINE NEEDLE ASPIRATION IN THE DIAGNOSIS OF SALIVARY GLAND LESIONS
Authors: Nettle W. J. S. , Orell S. R. 
Published: January 2008

Fine needle aspiration biopsy (fnab) of salivary glands was performed in 187 patients. In 106 patients with satisfactory fnab smears who proceeded to surgery, the original cytologic diagnosis was compared with subsequent histopathology. There were 74 benign tumours and 25 malignant tumours. Nineteen of the latter were primary malignant neoplasms of the salivary glands and 6 were metastatic. The cytologic diagnosis by fnab correlated exactly with the histologic diagnosis in 95% of benign neoplasms and in 68% of malignant neoplasms with an overall accuracy of 88%. A false negative diagnosis for malignancy was male in five cases and a false positive diagnosis in one case. Hence the sensitivity for malignancy was 80% and the specificity was 99%. The most frequently misdiagnosed lesions were pleomorphic adenoma and mucoepidermoid carcinoma.Fnab of salivary gland lesions is easy to perform and free of complications, but the cytologic patterns may be difficult to interpret, and considerable experience is necessary in order to achieve a high diagnostic accuracy.
SPLENECTOMY FOR IMMUNE THROMBOCYTOPENIC PURPURA: AUCKLAND EXPERIENCE 1979–87
Authors: Shaw J. H. F. , Clark M. A. 
Published: January 2008

Of 148 elective splenectomies performed in auckland during 1979‐s7, 48 were performed as therapy for immune thrombocytopenic purpura (itp). In all cases medical therapy had either failed to maintain their platelet count (36 patients), or side‐effects of medical treatment had made continuation unacceptable (12 patients).The mean age of the group was 31 years and there were 15 males and 33 females. Thirty‐four of 48 patients (71%) had a favourable response to splenectomy: platelet count was maintained above 150 × 109/1 and medical therapy was no longer required.There was no operative or inhospital mortality. Seven patienls experienced postoperative complications (mainly infections) of which none were life‐threatening.There was no difference in response between males and females (67% and 73% response rate, respectively), and the response rates of europeans and non‐europeans were similar (71% and 69%, respectively). By contrast, the average age of the responders ((29 years) was almost 10 years younger than the non‐responders (38 years).It is concluded that the use of splenectomy as therapy for patienls with itp. Who have either failed to respond to medical management or for various reasons cannot tolerate the complications associated with steroid therapy, is a safe procedure which in the present series was associated with no operative mortality and an acceptably low rale of morbidity. Younger itp patients (< 30 years) have a better chance of responding favourably to splenectomy than do older patienls (> 40 years).
SECRETION OF ANTIDIURETIC HORMONE IN NEUROSURGICAL PATIENTS: APPROPRIATE OR INAPPROPRIATE?
Authors: Poon W. S. , Mendelow A. D. , Davies D. L. , Watson W. , Easton J. , Morton J. 
Published: January 2008

In neurosurgical patients with hyponatraemia (plasma sodium <130 mmol/1) and natriuresis, increased antidiuretic hormone (adh) secretion may be appropriate rather than inappropriate. Ten such patients were studied prospectively to assess circulating adh concentration and body fluid volumes. Compared with a control group, the mean plasma adh level was significantly elevated (0.9 pmol/1 (s.e.m. = 0.2) versus 0.2 pmol/1 (s.e.m. = 0.1)), the total body water was normal (101% (s.e.m. = 3) versus 100% (s.e.m. = 6)), while the blood volume was significantly reduced (89% (s.e.m. = 3) versus 104% (s.e.m. = 5)).The elevated adh level was therefore appropriate to a reduced blood volume. This suggests that, in neurosurgical patients with hyponatraemia, fluid restriction could be dangerous. Serial observations in this small group of patients showed that salt replacement and normal fluid intake resulted in a fall in the elevated adh levels.
COMMON DUCT EXPLORATION OR ENDOSCOPIC SPHINCTEROTOMY FOR CHOLEDOCHOLITHIASIS?
Authors: Worthley C. S. , Watts J. McK. , Toouli J. 
Published: January 2008

The relative indications for operative common duct exploration (cde) and endoscopic spbincterotomy (es) in treating common duct stones are often unclear. This prospective study compared cde and es in treating choledocholithiasis after excluding patients with acute cholecystitis, idiopathic pancreatitis, sphincter of oddi dysfunction and malignant disease. One hundred and two patients had 105 cde and a further 50 patients had 57 es. Of the patients having cde, 76 also had cholecystectomy for gall‐bladder (gb) disease while 26 had prior cholecystectomy. With es, in 16 the gb was present and not removed while 34 patients had had prior cholecystectomy. Hospitalization was significantly less following es. There was one peri‐operative death after cde and none after es. There were two late biliary‐related deaths, 3 and 27 months after es, in patients who developed acute cholecystitis.In post‐cholecystectomy patients having es, complications were fewer and less severe after es (15%) than cde (41%). In patients with an intact gb, peri‐operative complications occurred in 30% after cholecystectomy and cde. Following es alone, complications occurred in 33% with the majority of these complications arising from the diseased gb. It is concluded that the optimal treatment for post‐cholecystectomy patients with bile‐duct stones is es. In elderly patients with an intact gb, the bile‐duct stones can be treated by es; whether subsequent cholecystectomy is necessary should be assessed on the likelihood of future gb complications.
‘HYPAFIX’: NEW TECHNIQUE OF SKIN GRAFT FIXATION
Authors: Cassey J. G. , Davey R. B. , Wallis K. A. 
Published: January 2008

A new technique for split skin graft fixation using ‘hypafixy’ adhesive dressing is described. Ninety‐three patients with bums involving < 20% body surface area grafted at the adelaide children's hospital during february 1985‐may 1987 were reviewed.Comparisons were made between the results of standard fixation and hypafix methods. The hypafix technique showed itself to be simple and reliable, affording considerable versatility and allowing early mobilisation without splintage or sedation. The adhesive is readily loosened with ungvita ointment allowing the dressing to be removed painlessly. In this study its use has shortened both the length of inpalient stay and outpatient follow‐up in the scar management programme.
ASCENDING AORTIC ANEURYSMS ASSOCIATED WITH AORTIC VALVE REGURGITATION: ST VINCENT'S HOSPITAL'S EXPERIENCE
Authors: Robotin M. C. , Chang V. P. , Shanahan M. X. , Farnsworth A. E. , Esmore D. S. , Spratt P. M. 
Published: January 2008

This report represents a retrospective analysis ol the m vincent s hospital experience with combined replacement of the aortic valve and ascending aorta using a composite conduit and coronary artery rcimplanlation, in 44 patients, from 1 january 1981 to 30 june 1988. The mean age at operation was 48 years annuloaorticectasia was the most common indication for operation in 24 patients (54%). There were three hospital deaths (77%). Forty‐one patients were discharged from hospital and were followed up for a total of 1106 patient months (mean = 26.5 months). There were three late deaths (7%). One death was due to a new dissection, one to a cerebrovascular accident and one to a drug overdose.So far, no patients have required reoperation. Of the 36 surviving patients available for follow‐up. 28 are in new york heart association class i. Seven patients are in class ii and one in class iii.Composite graft replacement reduces the risk of recurrent dissection and aneurysm formation and of penprosthetic leak. In the present experience, it is the method of choice in patients with degenerative lesions in the ascending aorta and aortic valve and particularly for annuloaortic ectasia. The exact surgical technique currently used has been the result of an evolution of different techniques.
REGENERATION AND PHAGOCYTIC FUNCTION OF DEVASCULARIZED SPLEENS
Authors: Clayer M. T. R. , Drew P. A. , Leong A. S‐Y. , Jamieson G. G. 
Published: January 2008

The phagocytic function of normal splenic tissue and of regenerated tissue following splenic artery ligation was investigated in rats using radiolabelled stannous fluoride colloid. Colloidal carbon was used to determine the histological location of phagocytosis within the spleen.Six months after ligation, the median weight of the devascularized spleens was 25% of that of spleens in control rats. Technelium stannous colloid clearance by devascularized spleens was reduced to 10% of normal and 25% when corrected for spleen weight.The colloidal carbon injected intravenously was observed primarily in the marginal zone in both normal and devascularized spleens.Histologically, devascularized spleens contained significantly less white pulp and marginal zone.The splenic tissue which regenerates following ligation does not have the phagocytic ability of normal splenic tissue. This may be due to the decreased regrowth of the lymphoid compartments of the spleen.
OUTCOME OF SURGERY FOR BILIARY ATRESIA
Authors: DORNEY S. F. A. , MIDDLETON A. W. , MARTIN H. C. O. , CUMMINS G. , SHUN A. , Gaskin K. J. , O'Loughlin E. V. , Kamath K. R. 
Published: January 2008

Forty‐seven infants (26 male, 21 female) with biliary atresia underwent hepatic portoenterostomy during the 16‐year period 1971–87. Twenty‐six patients (55%) are alive 1–17 years after surgery, with 21 (45%) being jaundice‐free. For children who became jaundice‐free, the mean age at surgery was 78 days (range: 34–125 days), compared with 97 days (range: 48–224 days) for those who did not. Of 39 patients operated on at less than 120 days of age, 24 (60%) are alive. All four patients operated on after 125 days of life died. Of 31 patients operated on more than 5 years ago, 12 (39%) have survived, the oldest being 17 years. Ten (32%) have normal serum bilirubin concentrations, have non‐active cirrhosis on liver biopsy, have had normal growth and development, and lead normal lives. The oldest two patients suffered variceal haemorrhage in their teenage years.In our recent experience, 11 of 16 patients (69%) have had complete clearing of jaundice, lead normal lives and do not currently require assessment for liver transplantation. It is believed that early referral of children with biliary atresia to experienced surgical units for portoenterostomy will lead to long‐term survival, without he need for liver transplantation in a majority of cases. Liver transplantation should be offered in infancy only after failed portoenterostomy, except for patients presenting after 120 days in whom transplantation may be considered primary therapy.
LIVER TRAUMA IN A MAJOR PERIPHERAL HOSPITAL: ANALYSIS OF MANAGEMENT AND MORTALITY IN 74 PATIENTS
Authors: MacLellan Donald G. , Cook David J. , McKay John R. 
Published: January 2008

The management of liver trauma has improved considerably over the past 2 decades. However, much of the evidence for this improvement has emanated from major trauma centres. Little information is available from peripheral hospitals which deal with much of the trauma seen in Australia. This study set out to examine the management of liver trauma in Box Hill Hospital over the past 2 decades; 74 patients were treated for liver trauma during 1967–86, and the factors considered contributory to mortality rate were analysed. The overall mortality rate was 33.8%, but each 5‐year period saw a reduction in mortality rate (25% in the 1982–86 period). The patient's age, associated injuries, transfusion requirements, degree of liver injury and postoperative haedage all contributed to a higher mortality rate.This study indicated that management of liver trauma in a peripheral hospital results in mortality rates that arc comparable with major trauma centres. Moreover, by highlighting treatment deficiencies through self‐audit, improved treatment protocols should further enhance survival prospects.
PROBLEMS AND LIMITATIONS WITH FINE NEEDLE ASPIRATION CYTOLOGY OF SOLITARY THYROID NODULES
Authors: Ananthakrishnan N. , Rao K. Madhava , Narasimhan R. , Veliath A. J. 
Published: January 2008

Fine needle aspiration cytology (FNAC) is a widely employed tool in the investigative work‐up of patients with single thyroid nodules. Although its advantages are well documented, the limitations and problems in interpretation of FNAC in this condition are not well known.Experience with FNAC in 150 patients with solitary thyroid nodules is presented, highlighting the pitfalls of this technique. There was an inadequate specimen rate of 22.7% which declined with increasing experience. Follicular carcinomas could not be differentiated from follicular adenomas by cytology. Difficulties may arise in the detection of papillary carcinomas due to occult lesions, mixed papillary and follicular carcinomas or due to associated thyroid pathology. False positivity is, however, much rarer and is generally due to cellular adenomatous goitres with marked papillary activity.In view of these cytologic limitations, care must be exercised by the treating physician in interpreting cytological results.
MODEL OF ORTHOTOPIC RENAL TRANSPLANTATION IN THE RABBIT
Authors: Francis D. M. A. , Millar R. J. , Dumble L. J. , Clunie G. J. A. 
Published: January 2008

A microsurgical method of orthotopic renal allotransplantation in the rabbit is described, and the result of 179 consecutive procedures are presented. There were 10 (5.5%) deaths within I week of transplantation. Earlp complications included vascular thrombosis (4.4%), and obstruction (6.7%) and fistula formation (0.6%) at the uretero‐ureteric anastomosis.This method of end‐to‐end vascular and ureteric anastomoses is straightforward and, in contrast to other models, does not require occlusion of the recipient inferior vena cava or aorta. use of a lone segment of donor ureter, or operation on the recipient bladder.