bluuebunny/crossref_metadata_2025_split huggingface dataset:
VASCULAR OUTFLOW RESISTANCE AND ANGIOGRAPHIC ASSESSMENT OF LOWER LIMB ARTERIAL RECONSTRUCTIVE PROCEDURES
Authors: Miller John , Walsh J. A. , Foreman R. K. , Dupont P. A. , Luethke R. , James M. J. , Iannos J. 
Published: January 2008

In an attempt to predict early graft occlusion secondary to poor distal run‐off, the outflow resistance was measured intra‐operatively and compared with the intra‐operative angiogram in 50 patients undergoing lower limb bypass procedures. With arterial inflow occluded, 60mL of plasmalyte was infused via a catheter and the resultant pressure generated in the graft was measured through a second catheter connected to a pressure transducer and recorder. Using the infusion rate and integrated pressure value, outflow resistance was calculated. High resistance measurements were defined as grafts with outflow resistance > 1.1 mmHg/mL per min, low measurements were defined as values < 0.5 mmHg/mL per min and intermediate measurements were those in the range 0.5–1.1 mmHg/mL per min.Angiograms were classified independently of resistance measurements by scoring the numbers of run‐off vessels crossing the ankle and stenoses, with subsequent assignment of the patient to one of three groups with either low, intermediate, or high probability of graft failure.Early graft failure was defined as cessation of graft function within 3 months of surgery. Early graft failure occurred in both cases with high outflow resistance and in seven of 44 with low outflow resistance. Of these nine occluded bypasses, six had been placed in the high probability of occlusion category on angiographic appearance and three in the intermediate category. Assessment of angiographic appearance and prediction of patency on a prospective basis had a sensitivity rate of 67% and a specificity rate of 78%. The corresponding sensitivity and specificity rates with resistance measurements were 22% and 100%, respectively. Thus, intraoperative angiographic assessment of the run‐off was more useful than outflow resistance measurement in predicting early graft patency.The presence of diabetes did not assist in the prediction of patients who subsequently developed early graft occlusion.
EFFECT OF A THROMBOXANE SYNTHETASE INHIBITOR UK‐38, 485 ON THE TOLERANCE OF SKIN FLAPS OF PRIMARY ISCHAEMIA
Authors: Mellow Cary G. , Knight Kenneth R. , Angel Michale F. , O'Brien Bernard Mcc 
Published: January 2008

The harmful effects of ischaemia or skin flaps were modified using the thromboxane synthetase inhibitor UK ‐ 38,485. The epigastric island flaps of Sprague‐Dawley rats (n= 288) were subjected to 10, 12 or 14 h of total pedicle occlusion, or 3, 5 or 7 h of venous occlusion of the sole vascular pedicle. Within each time period, rats received intravenous deoses of either physiological saline (controls) or UK ‐ 38,485 at the beginning or end of the ischaemic episode.Flaps treated with UK ‐ 38, 485 overall had a higher survival rate than control ischaemic flaps (P < 0.001). this applied both to total (arterial) ischaemia (P < 0.001) and partial (venous) ischaemia (P < 0.01). There was no significant difference between treatment given at the beginning or at the end of the ischaemic episode.These results may be explained by reduced platelet aggregation and thrombosis in the microvasculature due to the lower thromboxane/prostacyclin ratios for treated flaps. The possible inter‐relationship of the prostanoids with free radical mechanisms in the no‐reflow phenomenon is also discussed.
INTERHOSPITAL TRANSFER IN THE MANAGEMENT OF ACUTE TRAUMA
Authors: Deane S. A. , Gaudry P. L. , Woods W. P. D. , Read C. M. , McNeil R. J. 
Published: January 2008

During an 8‐month period, 538 injured patients were transferred from primary hospitals to a referral hospital for futher management of their injuries. Delay at the primary hospital was identified in 20% of all transfers and in 40% of patients transferred for management of head injury or multisystem injury. Delay at the primary hospital resulted in a median time from injury to arrival at the second hospital of 4 h. Defects in clinical management during transport included inexperienced escorts, inadequate airway control, ventilation. fluid resuscitation and stabilization of chest injuries. Nearly half of transfers were inappropriate because of the relatively minor nature of the injuries. Most of these had solitary musculoskeletal injuries to the extremities. These patients reflect the marked deficiency of specialist orthopaedic services in western Sydney during the study.Development of a metropolitan regional system of trauma care in western Sydney requires urgent action towards reducing the frequency of transfer, minimizing delays in transfer and maximizing basic resuscitation of seriously injured patients. Some designation of hospital roles is required and needs to be accompanied by a prehospital triage process. The population also has a right to expect adequate specialty services at suburban hospitals to enable treatment of minor and moderate single system injuries. Future trauma system developments should adequately retlect population growth and technological advances in clinical care.
PATTERNS OF OSSEOUS INJURIES AND PSYCHOSOCIAL FACTORS AFFECTING VICTIMS OF CHILD ABUSE
Authors: Krishnan Jeganath , Barbour P. Jane , Foster Bruce K. 
Published: January 2008

The aim of this paper is to document experience in the management of cases of child abuse with suspected osseous injury. at the Adelaide Children's Hospital, during the period January 1974‐December 1986. The study is a retrospective review of the casenotes, radiographs and radiologists' report of 108 consecutive cases with suspected osseous injuries. Information regarding the osseous injuries sustained and the psychosocial environment surrounding the circumstances of the patients admitted was recorded.Of 108 cases of suspected osseous injuries, 90% had confirmed osseous injury, of whom 56 cases (52%) had multiple fractures. Twenty of the 41 cases of single osseous injury were due to skull fractures. In children less than 12 months of age, long bone injuries were the most common form of presentation, and in 83% of these the injuries were multiple. Metaphyseal injury in association with other fractures was present in 14% of cases, and 8% of cases showed evidence of periosteal reaction to injury. There were two deaths during the period of this study, as a direct consequence of abuse. The main cause of death in both of these cases was the combination of cerebral haemorrhage and liver trauma. There were 10 other deaths not associated with fracture during this period.The analysis of psychosocial factors demonstrated that 48% of the children were first‐born and 67% of parents were unemployed. Of the alleged abuser, the mother was known to be responsible in 50% of cases. In 10% of cases. the parent responsible for the injury admitted to the offence at the time of presentation at the hospital. Of the 48 cases that presented again with a further non‐accidental injury, I I children were reinjured despite being seconded to foster homes, and the remaining 37 children suffered further abuse of different degrees after being returned to the homes of their biological parents.
RESULTS OF ULNAR NEUROPATHY AT THE ELBOW TREATED BY DECOMPRESSION OR ANTERIOR TRANSPOSITION
Authors: Davies M. A. , Vonau M. , Blum P. W. , Kwok B. C. T. , Matheson J. M. , Stening W. A. 
Published: January 2008

A retrospective study was conducted on 148 patients with ulnar neuropathy at the elbow, who underwent surgical treatment between 1981 and 1989.Of the 178 nerves operated on, 105 underwent subcutaneous anterior transposition, and 73 were decompressed without transposition. We compared the surgical results of these two groups, and factors influencing prognosis. Overall, 92% of patients improved postoperatively. Pre‐operatively, electrophysiological assessment corresponded well to clinical findings. and to macroscopic findings at operation in 95% of cases. The severity of pre‐operative clinical findings, advancing age, duration of symptoms and the presence of intra‐neural fibrosis did not predict an adverse outcome. A satisfactory outcome in 72% of those decompressed compared with 60% of those who were transposed was not statistically significant. However, there was a lower percentage of those with unsatisfactory results in the decompressed series. Thus, we advise that, except where there is persistent deformity or a mass lesion in the region of the ulnar groove. decompression is the operation of choice.
WARM BLOOD CARDIOPLEGIA AS AN ADJUNCT TO MYOCARDIAL PRESERVATION DURING CORONARY ARTERY BYPASS GRAFTING
Authors: Lubicz S. , Sullivan M. J. 
Published: January 2008

A review of the first 52 consecutive coronary artery bypass surgery patients to receive oxygenated blood cardioplegia, with warm reperfusion cadioplegia (‘hot shot’), was undertaken to evaluate its effectiveness in myocardial protection. The chosen parameters of ischaemia were: (i) the occurrence of ventricular fibrillation (VF) on release of the aortic cross‐clamp (ACC); (ii) the occurrence of bradycardia due to cardiac conduction defects; (iii) the use of inotropes with or without the use of the intra‐aortic balloon pump (IABP); (iv) evidence of myocardial infarction (MI) on the postoperative electrocardiograph (ECG); and (v) peri‐operative car‐diogenic mortality.Warm induction cardioplegia was cooled after cardiac standstill. Repeat cold cardioplegia was given as required at intervals and warm reperfusion cardioplegia was given prior to release of the ACC.Of the 52 patients studied none developed VF after release of the ACC; one patient with pre‐operative complete heart block required temporary cardiac pacing; no patient required inotropes or IABP and there was no postoperative MI or mortality.The warm blood cardioplegia technique has not resulted in any detectable evidence of inadequate myocardial protection. A beneficial effect has been demonstrated by the absence of VF, cardiac conduction defects, myocardial failure, MI and mortality.
DIAGNOSIS OF BREAST CANCER IN YOUNG WOMEN
Authors: Bennett I. C. , Jr R. Freitas , Fentiman I. S. 
Published: January 2008

While the prognosis of younger women with breast cancer is controversial, there have been sevet al significant reports indicating a more unfavourable outcome of the disease in this age group. A review has been conducted of the problems encountered in the diagnosis of breast cancer in younger women. The records of 227 consecutive patients aged 30–40 years who underwent breast biopsy were retrospectively analysed, and data studied in relation to the proportion of malignant to benign biopsies, the clinical and pathological features of the malignant cases, and the method of diagnosis. A total of 235 biopsies was performed in 227 patients, of which 199 were benign (85%) and 36 were malignant (15%). giving a malignant to benign biopsy ratio of 1:5.5. Thirty‐six cancers were diagnosed in 35 patients.Among these young women with breast cancer, the average duration of symptoms was 26 weeks, the mean clinical cancer diameter was 3.3 cm and only a small proportion (28%) of women had early (Stage I) disease. There were 4 women with breast cancer (11%), in whom the diagnosis of malignancy was unsuspected pre‐operatively. Mammography in these younger women appears to have a more limited role, with a sensitivity of only 76%.These findings indicate that the diagnosis of breast cancer in younger women is often more difficult than in older age groups and that the presentation and detection of such cancers is often delayed. Younger women need to be educated in relation to seeking early medical review of breast lumps and clinicians need to be aware of the limitations of mammography in such cases.
FREY'S SYNDROME FOLLOWING PAROTID SURGERY
Authors: Farrell M. L. , Kalnins I. K. 
Published: January 2008

Twenty‐one patients were followed up with a home visit after having parotid surgery at the Westmead Centre between January 1988 and October 1989. Nine of these patients (42.8%) had objective gustatory sweating as proven by Minor's Starch Iodine Test, with three of these (14.3%) having symptoms of Frey's syndrome. Symptoms started an average of 4.3 months after surgery. None of the three were anxious enough about their symptoms to seek medical treatment.Those patients with objective gustatory sweating were more likely to be women. No Statistical significance was found in regard to the presence or absence of greater auricular nerve section, facial nerve paresis, age or type of operation (superficial parotidectomy or otherwise).Frey's syndrome is a benign condition and explanation and reassurance are usually adequate therapy.
SPLENIC INJURY. AN ASSESSMENT OF SPLENIC CONSERVATION
Authors: Falk G. L. , Cregan P. C. , Kennedy C. W. 
Published: January 2008

Splenic salvage has been undertaken increasingly in the past decade. The optimal method is not determined in adults. Sixty‐seven consecutive cases of splenic injury were reviewed during a time of change in management policy. Splenic salvage rose from 10% of cases in 1980–83 to 57% in 1984–88. Treatment by observation resulted in 46% of patients undergoing delayed laparotomy. Injury to other intra‐abdominal organs required laparotomy in 23% of patients with multiple injuries.Operative splenic salvage in the adult is feasible and may result in a higher rate of splenic salvage.
COMPLICATED CROHN'S DISEASE IN THE OVER 70 AGE GROUP
Authors: Serpell J. W. , Johnson C.D. 
Published: January 2008

Crohn's disease is rare and is infrequently reported in the over 70 age group. Such patients often present urgently with acute complications of Crohn's disease. Seven patients with Crohn's disease all presented with complications. The diagnosis was initially unsuspected in these patients, and in 3 cases coexisting diverticular disease led to a delay in diagnosis. Three patients with ileocolic disease presented with peritonitis or bowel obstruction. In a further 2 patients a diagnosis of Crohn's disease was not made until after histological examination of resected tissue.It is likely that, as the population ages, more elderly patients will present with complicated Crohn's disease. Surgeons should be aware of this possibility to allow appropriate management of this condition, which generally has a favourable prognosis in this age group.
BECHET'S COLITIS A DIFFERENTIAL DIAGNOSIS IN INFLAMMATIONS OF THE LARGE INTESTINE
Authors: Kyle S. M. , Yeong M. L. , Isbister W. H. , Clark S. P. 
Published: January 2008

A previously well 39 year old woman presented with severe localized and painful anorectal ulceration. There were no other associated symptoms apart from arthritis of the hips and fingers. In the absence of definitive tissue diagnosis, a presumptive diagnosis of Crohn's disease was made. After a period of progression, the inflammation and ulceration subsided with conservative therapy.Following a relatively symptom‐free period of 7 years, painful ulceration recurred in the same segment of bowel, which was refractory to steroid therapy but responded to defunctioning of the rectum. Upon excision of the defunctioned rectum, multiple discrete ulcers developed in the remaining colon, with a fistula from the distal sigmoid colon to the midline wound. The patient simultaneously developed painful apthous ulceration of the mouth and throat, and pustules appeared on the perianal skin and trunk for the first time. A colectomy was performed, with good results. The pathology of the colonic lesions is described. The characteristic appearance of these lesions, together with associated ‘major’ and ‘minor’ clinical criteria, enabled a diagnosis of Bechet's disease to be made. Although there is some overlap, particularly in the distribution of this condition with Crohn's colitis, the pathologic appearances in Bechet's colitis are relatively distinct. A diagnosis of Bechet's colitis should not be excluded in a patient presenting with atypical inflammatory bowel disease, even if associated clinical criteria are not simultaneously present.
REGIONALEATION OF TRAUMA SERVICES IN WESTERN SYDNEY: PREDICTED EFFECT ON AMBULANCE AND HOSPITAL UTILIZATION RATES
Authors: Lyle D. M. , Thomson P. C. , Deane S. A. , Coulon L. A. 
Published: January 2008

A previous study has demonstrated the effectiveness of ambulance staff in identifying the majority of trauma victims who warrant admission to a Level 3 Hospital.1 This paper applies the results of that study in order to estimate the likely effect of a system of bypass whereby these identified patients are transported to a Level 3 hospital rather than the nearest Level 1 DT 2 Hospital.Under the proposed plan whereby both Westmead and Liverpool Hospitals would be granted Level 3 status, the effect on Westmead would be negligible. However, Liverpool's caseload would increase (25% for total admissions, 136% for serious admissions) and, consequently, its level of resources would need to be upgraded before this plan can be put into action. Meanwhile, Level 1 and 2 hospitals would see little change to total patient admissions, although there would be a substantial drop in serious admissions (‐63%).Under the proposed system, the effects on the Ambulance Service would also be negligible in terms of both the number of transports and total transport hours. However, the nature of these transports would change. More time would be required in bypass cases, although this would be compensated for by a corresponding fall off in interhospital transfers (28% decline in time spent on transfers). Ultimately, this means that patients would be getting to the hospital of definitive care much sooner. These results have implications for the development of trauma services in other sectors.
GASTROINTESTINAL CANCER FOLLOW‐UP: THE EFFECTIVENESS OF SEQUENTIAL CEA, TPA AND CA 19–9 EVALUATION IN THE EARLY DIAGNOSIS OF RECURRENCES
Authors: Barillari P. , Sammartino P. , Cardi M. , Rrcci M. , Gozzo P. , Cesareo S. , Cerasi A. 
Published: January 2008

One‐hundred and seventy‐four consecutive patients who underwent curative resection for gastric and colorec‐tal cancer between 1983 and 1985 were studied prospectively to evaluate the roles of sequential carcino‐embryonic antigen (CEA), tissue polypeptide antigen (TPA) and Ca 19–9 determinations and independent clinical examinations, in the early diagnosis of resectable recurrences. Sixty‐six recurrences (33 from gastric and 33 from colorectal cancer) were detected between 6 and 42 months after primary surgery. In gastric cancer CEA, TPA and Ca 19–9 showed a sensitivity of 64%. 73% and 60% respectively and a specificity of 67%. 65% and 54% respectively. Nine patients (27%) underwent surgical treatment for recurrent disease, and four of these (44.4%) had resectable recurrence, for a total resectability rate of 12%. Of these four patients, three are still living after 12, 36 and 44 months respectively from re‐operation without evidence of neoplastic disease. In one of these patients, re‐operation was performed on the basis of the elevation of the three markers, without any other clinical sign of disease. This patient had a resectable solitary hepatic recurrence. In colorectal cancer, CEA, TPA and Ca 19–9 showed a sensitivity of 73%. 73% and 49% respectively, and a specificity of 77%. 87% and 97% respectively. Fourteen patients (42.4%) underwent surgical treatment for recurrent disease and eight of these (57%) showed resectable recurrence, for a total resectability rate of 24.2%. Six patients are still living after 9, 16, 21, 31, 41 and 53 months respectively from re‐operation without evidence of neoplastic disease. In four cases the rises of the three marker levels was the one sign of recurrent disease. In one case, the operation revealed a peritoneal carcinomatosis, and in the other three cases resectable hepatic metastases were found. All these three patients are still living and disease‐free. In 46 cases, the rise in the value of CEA (35 cases) and/or TPA (34 cases) and/or Ca 19–9 (28 cases) was the first sign of recurrence. and the diagnosis was established later by clinical methods. In this group. the median time for diagnosis of recurrence, based on increase in initial markers comparison with routine clinical and instrumental follow‐up (lead time), was 3 months for liver metastases and 4 months for disseminated metastases.The results of our study indicate that a follow‐up programme based on CEA, TPA and Ca 19–9 assays is related to an early diagnosis and good resectability rate for recurrent gastric disease.
EVALUATION OF TRISS AS A MEANS OF SELECTING TRAUMA DEATHS FOR CLINICAL PEER REVIEW
Authors: Hill D. A. , Lennox A. F. , Neil M. J. , Sheehy J. P. 
Published: January 2008

This study was carried out to evaluate the predictive power of a mathematical model called TRISS in identifying avoidable trauma deaths when compared with peer review (PR).The subjects studied comprised the 24 deaths that occurred among 81 severely injured patients (Injury Severity Score ≥ 16) admitted to a trauma unit over a 1 year period.Sixteen patients who had a > 50% probability of survival (Ps) calculated by TRISS died. Peer review concluded that five of those were potentially avoidable deaths. Eight deaths occurred in patients with a Ps less than 50%. Peer review regarded those eight as inevitable deaths.The data. when analysed, showed TRISS to have a 100% sensitivity, 42% specificity, 31% positive predictive value and a negative predictive value of 100% when compared with peer review.It is concluded that TRISS tends to over‐estimate potentially avoidable death, especially in patients with severe head injury. However it is a good audit filter as it reliably excludes inevitable death.
IATROGENIC INJURIES TO THE EXTRAHEPATIC BILIARY TRACT
Authors: Richardson A. J. , Tait N. , Muguti G. , Little J. M. 
Published: January 2008

Iatrogenic injuries to the extrahepatic biliary tract continue to occur and result in significant morbidity. Over the last 10 years, 26 patients have been referred to Westmead Hospital for management of iatrogenic biliary tract injuries. Of these injuries, 22 occurred during cholecystectomy, three during hepatectomy and one during a pancreaticoduodenectomy. The principles of avoidance and repair are discussed.It is concluded that these injuries, although uncommon, continue to occur and that the best treatment results are achieved in specialized hepatobiliary units.
HOW ACCURATE IS A COMPUTERIZED SURGICAL AUDIT WHEN RESIDENT MEDICAL STAFF COLLECT THE DATA?
Authors: Castleden W. M. , Norman P. E. , Stacey M. C. , McGechie D. , Brooks J. G. , Fisher J. , Lawrence‐Brown M. M. D. 
Published: January 2008

Since July 1988 all eight general surgeons at Fremantle Hospital have used a computer‐based surgical audit and discharge system. At the time of writing (September 1991) 10919 computer‐generated discharge letters have been produced by the system.This paper describes the system and reports a series of quality control assessments carried out between 1 July 1988 and 30 June 1990 during which 30 pre‐registration surgical residents completed 5716 data collection forms. It was found that:(1) data collection for 23 of 24 monthly surgical audits was at least 95% complete;(2) outstanding surgical discharge summaries were reduced by 89%;(3) the residents recorded 17/19 wound infections and identified 15 (79%) of these as a surgical complication; and(4) the residents tended to under‐record complications in patients who had more than one complication during their hospital stay.It was concluded that the system was robust, and that resident staff collected data in such a way that good quality computer‐generated discharge letters were produced in a timely manner. Closer attention to aspects of data collection will be required before the optimum surgical audits of the QX system can be generated.