bluuebunny/crossref_metadata_2025_split huggingface dataset:
AORTIC TRANSECTION
Authors: Cameron P. A. , Dziukas L. , Hadj A. , Hooper S. , Tatoulis J. 
Published: January 2008

Background: Traumatic aortic transection is uncommon in those trauma patients reaching hospital alive. Methods: The Victorian Major Trauma Study (VMTS) received data from 25 hospitals in Victoria, a State of 4.4 million people, and identified 1874 patients with blunt trauma and Injury Severity Score (ISS) greater than 15 over a 2‐year period (1 March 1992–28 February 1993 and 1 May 1994–30 April 1995). The Federal Office of Road Safety (FORS) examined coronial data from 1 January 1992 to 31 December 1992. These studies allowed a retrospective, population‐based review of experience with aortic transection. Results: The VMTS identified 19 patients who reached hospital, with signs of life at the scene of the accident, during a 2‐year period. Of these, 8 left hospital alive: 4 without disability and 4 with disability related to non‐thoracic injury. The annual incidence of aortic transection for the State, based on FORS data, was 13 per 1 000 000, lower than other reported studies. Review of the management of patients in hospital confirmed the usefulness of initial chest X‐ray in diagnosis and the high incidence of associated injury. Conclusions: The study raises a number of issues, including the question of direct referral of patients with severe chest injury to hospitals with cardiothoracic facilities, increased use of transoesophageal echocardiography in diagnosis and increased use of immediate laparotomy and thoracotomy in certain patients.
COMPUTERS IN MEDICAL EDUCATION 1: EVALUATION OF A PROBLEM‐ORIENTATED LEARNING PACKAGE
Authors: Devitt Peter , Palmer Edward 
Published: January 2008

Background: A computer‐based learning package has been developed, aimed at expanding students' knowledge base, as well as improving data‐handling abilities and clinical problem‐solving skills. The program was evaluated by monitoring its use by students, canvassing users' opinions and measuring its effectiveness as a learning tool compared to tutorials on the same material. Methods: Evaluation was undertaken using three methods: initially, by a questionnaire on computers as a learning tool and the applicability of the content; second, through monitoring by the computer of student use, decisions and performance; finally, through pre‐ and post‐test assessment of fifth‐year students who either used a computer package or attended a tutorial on equivalent material. Results: Most students provided positive comments on the learning material and expressed a willingness to see computer‐aided learning (CAL) introduced into the curriculum. Over a 3‐month period, 26 modules in the program were used on 1246 occasions. Objective measurement showed a significant gain in knowledge, data handling and problem‐solving skills. Conclusions: Computer‐aided learning is a valuable learning resource that deserves better attention in medical education. When used appropriately, the computer can be an effective learning resource, not only for the delivery of knowledge, but also to help students develop their problem‐solving skills.
RECURRENT BENIGN PAROTID TUMOURS: THE LESSON NOT LEARNT YET?
Authors: Patel Nirmal , Poole Alan 
Published: January 2008

Background: To study the behaviour of recurrent benign parotid tumours, recurrence characteristics and problems faced with the removal of these lesions. Methods: We reviewed the charts of the work of a single surgeon between 1971 and 1996. Results: There were 24 patients (13 women, 11 men) with a mean age of 44 years at re‐operation. Mean follow‐up period was 10 years (range 1–22 years). There were 21 recurrent pleomorphic adenomas, two monomorphic adenomas and one patient with recurrent oncocytoma. Nine patients had solitary recurrence with a mean size of 14 mm, 15 patients had multiple recurrences with a mean size of 8 mm. There was malignant transformation of a previously benign lump in one patient. Three patients presented with a second or third recurrence. Overall facial nerve paralysis was 53% (38% temporary and 15% permanent). Frey's syndrome occurred in four patients (17%). Conclusions: Recurrent benign parotid tumours are uncommon if superficial parotidectomy (SP) is the performed initially; recurrence rates are between 0–4%. The recurrences are usually slow growing and require lengthy follow‐up. Pre‐operative diagnosis of a lump in the region of previous excision is useful in treatment planning. Malignant transformation in previous benign lump should be considered and fine needle aspiration biopsy may help in diagnosis. Facial nerve injury is more likely if the tumour is deep, in multiple sites or involves extensive scar tissue. Radiotherapy is controversial, it should be considered if there has been tumour spillage following re‐operation.
FUNCTIONAL RECOVERY AND TIMING OF HOSPITAL DISCHARGE AFTER PRIMARY TOTAL HIP ARTHROPLASTY
Authors: Wang Allan , Ackland Timothy , Hall Sonia , Gilbey Helen , Parsons Richard 
Published: January 2008

Background: Early discharge programmes in hospitals are encouraged to increase financial efficiency and bed availability, but standards of clinical care must not be compromised. Criteria for safe hospital discharge must be established and objective data are needed to assess how rapidly patients can achieve these discharge criteria. Methods: A prospective study was performed on 65 patients (mean age = 71 years) scheduled for primary total hip arthroplasty (THA). The Modified Barthel Index (MBI) was measured pre‐operatively and postoperatively at set intervals to assess recovery of function after THA. A score of 90 out of possible 100 was used as discharge criterion and indicated that the patient was functionally independent for safe hospital discharge. In addition, combined score for thigh flexion and extension isokinetic peak strength was recorded for each patient before and after surgery. The number and nature of comorbidities and complications were also recorded. Results: The length of hospital stay in this sample varied from 5 to 39 days. The MBI scores increased rapidly between days 3 and 5, then began to plateau from day 8 onwards. Based on the MBI, 58% of patients were fit for discharge at or before day 8. The remainder were fit for discharge from day 10 onwards (mean = 14.2 days). The latter group who required an extended hospital stay were older (P= 0.003), had more identified comorbidities (P= 0.01) and were weaker in their hip musculature prior to surgery (P= 0.01), compared to those who were discharged by day 8. A logistic regression analysis indicated that the pre‐operative MBI score and hip strength score were strong predictors of timing for hospital discharge. Conclusions: A clinical pathway with functional milestones laid out over 8 days would be an appropriate criterion for the discharge of the majority of patients. However, approximately 40% of the patients presented in this study required longer hospital stay before the criteria for safe discharge could be achieved. These patients can be identified pre‐operatively by screening their MBI and composite hip strength scores.
HOW SHOULD WE INTRODUCE HIGH‐DOSE CHEMOTHERAPEUTIC STRATEGIES INTO THE ADJUVANT MANAGEMENT OF HIGH‐RISK BREAST CANCER IN AUSTRALASIA?
Authors: Back M. , Delaney G. , Denham J. , Graham P. , Hamilton C. , Morgan G. , O'Brien P. , Yuile P. 
Published: January 2008

Background: Development of bone marrow support techniques has altered the standard chemotherapeutic management of haematological malignancies, and these techniques are now being increasingly utilized in solid tumours. In breast cancer, survival benefits have resulted from conventional dose adjuvant chemotherapy, but outcomes remain poor in many women with high‐risk disease. Improved response rates with high‐dose chemotherapy (HDC) in metastatic disease have led to the investigation of these techniques in adjuvant therapy of high‐risk localized disease. In some high‐risk patient subgroups survival is extremely poor, with 5‐year rates below 30%. Improved adjuvant strategies for patients in these subgroups are therefore urgently required. In Australasia, oncology departments are currently considering accrual of women with high‐risk disease into the International Breast Cancer Study Group (IBCSG) 15–95 Trial investigating HDC/stem cell transplantation. Methods: The present paper reviews the available data on the efficacies and toxicities of currently available high‐dose chemotherapeutic strategies; discussing methodological considerations relevant to their introduction and safe use in the adjuvant setting in Australia and New Zealand. Results: Although response rates with HDC in metastatic disease are encouraging, the clinical effectiveness of current HDC regimens in adjuvant management has not been established and is limited by significant toxicity. Conclusions: The introduction of HDC strategies for high‐risk breast cancer in Australia encounters difficulties both in trial design and potential clinical practice.
CLINICAL AND RADIOLOGICAL PREDICTORS OF COMPLETE EXCISION IN BREAST‐CONSERVING SURGERY FOR PRIMARY BREAST CANCER
Authors: Kollias J. , Gill P. G. , Beamond B. , Rossi H. , Langlois S. , Vernon‐Roberts E. 
Published: January 2008

Background: Local recurrence after conservative surgery for breast cancer usually results from growth of residual cancer adjacent to the excised primary tumour or from multicentric disease. Complete local excision (CLE) confirmed histologically is essential to ensure that the risk of local recurrence is minimal. This study was undertaken to determine that clinical or radiological factors may assist the surgeon at the time of surgery to achieve this aim. Methods: A retrospective review of 101 cases treated by conservative surgery identified 70 cases of CLE and 31 of incomplete local excision (ILE). Clinical, surgical and histopathological data were taken from hospital records. Mammographic features and those of specimen X‐rays were evaluated without knowledge of the histopathological outcome of surgery. Results: Complete excision was significantly associated with type of operation (lumpectomy vs wide local excision/quadrantectomy, P < 0.003), absence of calcification (P < 0.03) and the presence of a mass on mammography (P= 0.05). Tumour size (> 2.5 cm) and the presence of extensive ductal carcinoma in situ (DCIS) were associated with incomplete excision (P= 0.0005). No relationship was demonstrated with patient age, breast size, breast density, tumour grade, receptor status, axillary nodal status or spicules on X‐ray and completeness of excision. Specimen X‐ray had a positive predictive value of 94% with CLE. Conclusions: Clinical and pre‐operative mammographic parameters are important for predicting CLE for breast cancers treated by breast‐conserving surgery. Specimen radiology for palpable lesions can confirm excision of the cancer and permit re‐excision of breast tissue at the time of initial surgery. Its role in determining CLE should be further evaluated.
TREATMENT OF LARGE, PERSISTENT LYMPHOCOELES USING AN ARGON BEAM COAGULATOR AND TALC
Authors: Vrouenraets B. C. , Thompson J. F. , McCarthy W. H. 
Published: January 2008

Background: Lymphocoele formation can be a troublesome surgical complication after lymph node dissection and mobilization of large skin flaps. Occasionally, lymphocoeles persist for prolonged periods despite repeated aspiration. Treatment by sclerotherapy has been recommended, but this requires a prolonged treatment time and often causes intense pain. Methods: The technique used to treat large, persistent lymphocoeles involved ‘painting’ the lymphocoele wall with an argon beam coagulator after evacuating its contents. Sterile talc was then distributed liberally through the cavity, a closed suction drain placed and the wound closed. Results: The procedure was completely successful in each of the four patients treated. After a mean follow–up period of 11 months (range 6–15 months) no lymphocoele recurrence has occurred. Conclusions: Use of an argon beam coagulator and talc reliably achieves rapid, definitive obliteration of large, persistent lymphocoeles.
INGUINAL HERNIA REPAIR: A COMPARISON BETWEEN LOCAL AND GENERAL ANAESTHESIA
Authors: Subramaniam P. , Leslie J. , Gourlay C. , Clezy J. K. A. 
Published: January 2008

Background: A comparative analysis of outcomes of inguinal hernia repair performed under local (LA) and general anaesthesia (GA) by a single surgeon using a standardized technique of anterior transversalis repair was performed. Ninety‐three cases were examined, 56 of which were cases of LA hernia repair. Methods: A retrospective analysis of the patient hospital record was performed with particular attention to intra‐operative and postoperative analgesia requirements. Results: An overall series complication rate of 6.5% (6/93) is reported. Only one of 56 LA patients (2%) required more than 24 h of narcotic analgesic injections compared to 11% (4/37) in the GA group (P < 0.05). The mean total postoperative parenteral narcotic requirement in the LA group was 86 ± 14 mg of pethidine as compared to the GA group who had a mean total requirement of 121 ± 17 mg of pethidine (P > 0.08). Conclusions: The LA infiltration technique is an effective method for inguinal hernia repair. This series demonstrates benefits in terms of length of hospital stay and a lower incidence of postoperative parenteral narcotic analgesic requirement although when postoperative parenteral narcotics were required by the LA group of patients, the difference in mean total pethidine requirement was not statistically significant.
CELLULAR POTASSIUM DEPLETION PREDISPOSES TO HYPOKALAEMIA AFTER ORAL SODIUM PHOSPHATE
Authors: Hill Andrew G. , Teo Wee , Still Andrew , Parry Bryan R. , Plank Lindsay D. , Hill Graham L. 
Published: January 2008

Background: Oral sodium phosphate has become an attractive alternative to polyethylene glycol for colonic cleansing preparatory to elective colorectal surgery. Its use, however, has been associated with hypokalaemia. The authors of the present study tested the hypothesis that patients with cellular depletion of potassium are at significant risk for hypokalaemia with oral sodium phosphate bowel preparation. Methods: In 23 patients, total body potassium was measured by whole‐body counting and intracellular water volume was measured by bioimpedance analysis before oral sodium phosphate bowel preparation. Patients were divided into those whose serum potassium fell to 3.5 mmol/L or lower (Group 1) and those whose did not after sodium phosphate treatment (Group 2). Results: The fall in serum potassium concentration over the period of oral sodium phosphate administration was significantly negatively correlated with intracellular potassium concentration measured prior to administration (r=‐0.65, P= 0.0009). In Group 1, serum potassium concentration fell from 4.1 ± 0.1 (standard error of the mean (SEM)) mmol/L to 3.2 ± 0.1 mmol/L (P± 0.0001) while in Group 2 there was no significant change in this concentration (4.0 ± 0.1 vs 3.9 ± 0.1 mmol/L) as a result of sodium phosphate treatment. Intracellular potassium concentration prior to administration of sodium phosphate was significantly lower in Group 1 (117 ± 9 mmol/L vs 143 ± 7 mmol/L, P < 0.05). Conclusions: Caution should be exercised when treating patients with oral sodium phosphate who are considered to be cellularly depleted of potassium. These patients are at risk of hypokalaemia after this treatment.
IMPROVEMENTS IN PARATHYROID SURGERY IN THE INTACT 1–84 PTH ASSAY ERA
Authors: Carnaille B. , Oudar C. , Pattou F. , Quievreux J. , Proye C. 
Published: January 2008

Background: Measurement of intact 1–84 parathormone (PTH) level by immunometric assays has been an important tool in the medical management of hypercalcaemia. The aim of the present study was to evaluate its practical contribution in the diagnosis and surgical treatment of primary hyperparathyroidism. Methods: The results of surgery were compared (number of failed and inadequate cervicotomies, number of overlooked cervical glands) in two groups of primary hyperparathyroid patients operated on without (group I, n= 624) and with (group II, n= 360) intact PTH evaluation. The postoperative intact PTH level was measured 1–50 months after surgery in 109 unselected normocalcaemic patients. The benefit of intact PTH assay was studied in borderline patients. We tried to settle a correlation between parathyroid resected weight and intact PTH pre‐operative level in different subsets of the disease. Results: The sensitivity for the diagnosis of primary hyperparathyroidism was 86.6% for intact PTH level alone, and 95.9% when plotted with synchronous serum total calcium. Hyperfunctional adenoma was incidentally discovered in 14 asymptomatic normocalcemic normo‐PTH patients. The predictive positive value of intact PTH assay for the diagnosis of primary hyperparathyroidism was 99.3%. Intact PTH assay often affirmed the diagnosis of primary hyperparathyroidism in borderline cases. The postoperative intact PTH measurement was not a good indicator for evaluating the late outcome in seemingly cured patients. Sharp but statistically significant correlation was found between the resected weight and the intact PTH level. The discovery of a small adenoma in a patient with high intact PTH level, bone disease and low vitamin D level should raise suspicion of a second hyperfunctioning gland. Conclusions: Intact PTH assay was a main contributor to the surgical management of primary hyperparathyroidism, reducing the number of unnecessary cervicotomies and enabling the cure of all cases of primary hyperparathyroidism except those due to mediastinal glands. It raised unanswered problems in the late postoperative course.
TANDEM URETEROCYSTOPLASTY
Authors: Ahmed Saeed , Neel Khalid Fouda , Sen Sudipta 
Published: January 2008

Background: Bladder augmentation may be undertaken by using various gastrointestinal segments but their use is associated with a multitude of well‐recognized complications. The mega‐ureter has proven to be a satisfactory alternative; in patients with bilateral mega‐ureters, both ureters may be used for this purpose. Methods: Seventeen patients had augmentation ureterocystoplasty, including three in whom both distal ureters were used in tandem. The latter included two patients with neurogenic bladder and one with bladder exstrophy. Results: Satisfactory augmentation was achieved in all patients undergoing tandem ureterocystoplasty. The neurogenic bladder patients are managed by urethral clean intermittent catheterization (CIC) and the exstrophy patient is managed by CIC of an appendico‐vesicostomy (Mitrofanoff). All are continent. Conclusions: The mega‐ureter provides an excellent source of augmentation material in patients with small non‐compliant bladders. In those with bilateral mega‐ureters, consideration should be given to using both ureters in tandem to achieve the maximum possible bladder capacity.
CLINICAL MANAGEMENT AND TREATMENT OUTCOMES OF MERKEL CELL CARCINOMA
Authors: Wong Kenneth C. , Zuletta Fred , Clarke Stephen J. , Kennedy Peter J. 
Published: January 2008

Background:Merkel cell carcinoma (MCC), first described in 1972, is an uncommon, highly malignant tumour of skin. Its aetiology is unknown although the tumour occurs most frequently in sun‐exposed sites. This skin cancer is characterized by a high incidence of metastases, local and regional recurrence and has a high mortality. Few survival data beyond 3 years are available. Treatment strategies include wide local excision of the primary and lymph node dissection, as indicated together with adjuvant radiotherapy. The tumour has also been shown to be chemosensitive. Definitive treatment is inconclusive due to the relative rarity of this malignancy.Methods:A retrospective study was undertaken between the years 1985 and 1996 of 33 patients with MCC at Concord Repatriation General Hospital (CRGH). Demographic details were noted, together with the site and appearance of the primary lesion and the sites and date of metastases. The response and outcome to various modalities of treatment were documented.Results:There were 27 men and six women with an average age of 80 years (range: 60–86 years). The primary lesion in the present series most often resembled a basal cell carcinoma (BCC), with 53% occurring in the head and neck region. Twenty‐seven patients (82%) developed metastastic disease, with an average interval of 13.4 months between diagnosis of the primary lesion and the development of metastases. The incidence of locoregional recurrence in the present series was 42%. Radiation combined with surgery achieved locoregional control in 15 of 19 patients with primary, regional or recurrent locoregional disease. Fourteen patients died of MCC and five others from unrelated causes. The 14 survivors have a mean survival of 54 months with six patients surviving more than 5 years.Conclusions:Local excision together with regional lymph node clearance as indicated, combined with adjuvant radiation treatment was associated with an improved survival. The role of chemotherapy remains unclear.
BREAST CANCER OUTCOMES AT THE STRATHFIELD BREAST CENTRE
Authors: Loveridge Katrina H. , Kennedy Catherine W. , Janu Norman C. , Carmalt Hugh L. , Gillett David J. 
Published: January 2008

Background:Breast cancer is the most commonly diagnosed cancer and the most common cause of cancer death in women. This report presents outcomes from a multidisciplinary breast clinic established in 1989 with the specific aim of providing a rapid, integrated assessment service for patients with breast disease.Methods:A prospective data collection and analysis using a Microsoft AccessTM (Microsoft Corp., North Ryde, NSW, Australia) database was established and has collected information on all patients presenting for diagnosis or ongoing management of breast cancer. Data on survival were obtained by routine follow‐up visits or contact with the patient'general practitioner.Results:Patient age, mode of presentation and histopathology were similar to other population‐based studies in Australia. Ninety‐three per cent of the patients had a diagnosis confirmed on the day of consultation. The average time between diagnosis and surgery was 11.9 days. Breast preserving surgery was attempted in 68% and achieved in 50% of cases, 67% of patients had one stage surgery. Five‐year disease‐free survival was 74% and is comparable with other reports.Conclusions:The centralization of services and expertise has enabled us to provide efficient service and achieve internationally comparable outcomes.
NON‐OPERATIVE TREATMENT OF BREAST ABSCESSES
Authors: Tan S. M. , Low S. C. 
Published: January 2008

Background:Breast abscesses are conventionally treated by incision and drainage. This often requires general anaesthesia and a hospital stay. Non‐operative treatment by needle aspiration and oral antibiotics is reported as a viable alternative.Methods:All patients who presented with breast abscesses and who were assessed by one surgeon between November 1995 and January 1997 were managed using a conservative approach and they are the subjects of this study.Results:Twenty‐one consecutive patients were seen over a period of 26 months. All had non‐lactational breast abscesses. Nineteen patients were successfully treated by needle aspiration and antibiotics while two patients required incision and drainage. The mean size of the aspirated abscesses was 3.5 cm (range 1–15 cm) and required an average of 2.4 aspirations (range 1–5). Of those treated by aspiration, three patients developed recurrent abscesses, two of which were successfully managed by repeat aspiration while one patient eventually required surgery.Conclusions:The majority of non‐lactational breast abscesses seen in clinical practice can be treated without surgery by a combination of needle aspiration and antibiotics.