bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE RESULTS OF CORACO‐CLAVICULAR SLINGS FOR ACROMIO‐CLAVICULAR DISLOCATION
Authors: Clayer M. , Slavotinek J. , Krishnan J. 
Published: January 2008

Background: Treatment of type 3 acromio‐clavicular (A‐C) dislocations is controversial. There have been over 60 different surgical procedures as well as a variety of conservative measures used to treat this injury. Methods: The outcome of a coraco‐clavicular (C‐C) sling for grade 3–4 A‐C dislocation was studied. A dissolvable sling of braided 1 polydioxanone (PDS, Ethicon) was used with or without excision of the distal end of the clavicle in six patients. The clinical and radiological outcome of the braid and acromio‐clavicular joint were studied by clinical examination, plain and stress radiographs and magnetic resonance imaging (MRI). Results: All patients reported good‐excellent results from 6 months after surgery. Radiological examination demonstrated some superior clavicular migration in all patients within 1 month of the procedure, although never more than that seen with a grade 2 dislocation. This migration was clinically evident only in patients with a thin build. At 1 month, the MRI demonstrated partial replacement of the braid by granulation tissue. From 6 months on, the braid was absent and fibrous tissue was noted between the coracoid and the clavicle and the acromion and clavicle. Conclusions: The coraco‐clavicular sling did not maintain operative reduction of the dislocated clavicle. This did not diminish the functional result but was a cosmetic complication in patients with a thin build.
SAFETY OF SILICONE LIQUID IN THE POSTOPERATIVE MANAGEMENT OF DUPUYTREN'S CONTRACTURE
Authors: Thurston Alan J. 
Published: January 2008

Background: Recently the New Zealand Department of Health expressed concerns about the safety of applying silicones to open wounds and banned their use. For 30 years silicone liquid has been used for the management and rehabilitation of the injured hand. It has been reported that the application of silicone fluids to the skin and ordinary handling over a period of years of various methyl and phenyl polymers by laboratory workers caused no skin disorders or sensitization, nor was absorption observed. There are no reports in the literature of the safety of the use of silicones applied to open wounds. Methods: In the present study, 116 hands that had been mobilized in silicone liquid following surgery for Dupuytren's contracture over the last 12 years were reviewed. In the cases of 64 hands, the patients could be traced and contacted, and 47 patients (hands) agreed to attend for a clinical review. The hands were examined for areas of inflammation, granuloma formation and abnormal scar formation. Results: No patient showed any evidence of adverse effects from the use of silicone liquid. Conclusions: There is no evidence that the use of silicone liquid, in contact with open wounds of the hands, for the mobilization of the hand following surgery for Dupuytren's contracture has any of the adverse effects reported as being associated with implanted silicone prostheses.
TYPHOID ENTERIC PERFORATION
Authors: Talwar Sachin , Sharma Rakesh K. , Mittal Dinesh K. , Prasad P. 
Published: January 2008

Background: Perforation of the bowel is the most serious complication of typhoid fever. The role of early limited surgery in managing these patients needs to be assessed. Methods: The records of 110 cases of typhoid enteric perforation treated at JLN Hospital, Ajmer between 1990 and 1995 were reviewed. Results: A total of 42.7% of the patients were in the 21—30‐year age group, and 83.6% were male. All patients presented with the classic features of typhoid enteric perforation. A total of 83.6% were operated on within 36 h of perforation. Surgical management consisted of primary closure of the perforation (74.5%), closure with omental graft (14.5%), resection and anastomosis (3.6%), and only drainage (7.3%). A total of 79.1% of patients developed wound infection and 10% of patients developed faecal fistula. The overall mortality rate was 16.4%. Increasing the time interval between perforation and operation significantly increased the mortality (P < 0.05). The mortality was least with early primary closure of the perforation. Patients with postoperative faecal fistula had higher mortality rates (P < 0.001). Conclusions: Early limited surgery with thorough peritoneal lavage provides optimal results, faecal fistula is a grave complication, and the use of the McBurney incision may provide better results in terms of subsequent wound healing.
PERCUTANEOUS MICROCOIL EMBOLIZATION OF INTRAPERITONEAL INTRAHEPATIC AND EXTRAHEPATIC BILIARY FISTULAS
Authors: Hunt J. A. , Gallagher P. J. , Heintze S. W. D. F. , Waugh R. , Shiel A. G. R. 
Published: January 2008

Background: Persistent intraperitoneal biliary fistulas are associated with significant morbidity and mortality. Percutaneous drainage, stenting, and endoscopic sphincterotomy or embolization of biliary radicals have largely replaced the need for hepatic resection or biliary reconstruction in managing such fistulas. When endoscopy is contraindicated, a previously undescribed technique of percutaneous embolization of intrahepatic and extrahepatic biliary fistula following penetrating liver trauma, and orthotopic liver transplant and its application in three patients, will be discussed. Methods: Embolization procedures were performed by an interventional radiologist. Percutaneous trans‐hepatic cholangiography via a standard right‐side approach or via tube cholangiography was initially performed and the fistula defined. Coaxial catheter systems were used (5 Fr angiography catheters and Tracker 18 infusion catheters), and were positioned within the biliary tree as close as possible to the origin of the fistula. Embolization was performed using vascular Embolization 28 coils (WA Cook) 2–3 mm × 2 cm coils, straight Hilal 18 embolization coils (WA Cook) 5–7 cm, as well as Gelfoam (Upjohn) 1 mm pellets, and Histoacryl (B. Braun) 0.25–1 mL. Occlusion of the duct was confirmed by a selective intrahepatic cholangiogram. In cases of multiple fistulas several embolizations were performed at subsequent procedures. Follow‐up is over 13 months without adverse event. Results: The technique was used in the three cases and was successful in all. A peripheral biliary fistula required embolization twice and two cystic leaks were cured after a single attempt. Conclusions: Percutaneous embolization of biliary fistulas provides a management option in cases where conservative treatment has failed and other techniques are relatively contraindicated. The technique is effective and safe in skilled hands, and avoids major surgery. The long‐term effect of microcoils in the biliary tree is unknown.
THE EFFECT OF ARTERIAL CLAMP DURATION ON ENDOTHELIAL INJURY: AN EXPERIMENTAL STUDY
Authors: Margovsky A. I. , Lord R. S. A. , Chambers A. J. 
Published: January 2008

Background: Arterial clamp‐related endothelial damage was investigated in an animal model to quantify the surface area of endothelial disruption. The influence of the duration of clamp application on this damage was evaluated. Methods: Four identical angled DeBakey vascular clamps were applied on each of eight carotid arteries in four heparinized adult sheep for durations of 15, 30, 45 and 60 min. The applied clamping forces were measured and kept constant. After the last clamp was removed, the areas of endothelial loss were identified by in vivo staining with Evan's blue dye. The vessels were excised and the blue stained areas measured by computer‐assisted analysis. The morphological appearance of the specimens was assessed by scanning electron microscopy. Results: Endothelial damage following clamping for 15 min (10.6 ± 4.3 mm2) was significantly less than for 30 min (19.0 ± 4.7 mm2), 45 min (19.8 ± 4.6 mm2) and 60 min (20.7 ± 4.9 mm2; P= 0.005), but there were no significant differences between the areas of endothelial loss observed for 30, 45, and 60 min. These results corresponded to the damage seen using scanning electron microscopy, which showed partial disruption of endothelium at 15 min compared to more complete destruction at longer durations. Conclusion: Evan's blue staining combined with computer‐assisted surface area measurement is an accurate method for quantifying endothelial damage. The extent of damage caused by vascular clamps is partly time‐dependent, being less for 15 min than for 30 min of clamping, but not significantly increasing for durations greater than 30 min.
THE LOWER TRAPEZIUS ISLAND MYOCUTANEOUS FLAP FOR RECONSTRUCTION OF SOFT TISSUE OF THE LATERAL SKULLBASE AND NECK
Authors: Cole Ian 
Published: January 2008

Background: The lower trapezius island myocutaneous flap (LTIMF) has been described as a method of reconstruction after excision of carcinoma of the head and neck. A high rate of failure and confusion regarding the nomenclature of its vascular supply has been reported in the literature. Methods: The data on six patients whose lateral skullbase and upper neck were reconstructed with an LTIMF were assessed prospectively. Results: There was one major flap loss, and one previously irradiated patient had a minor dehiscence. One patient had a small haematoma at the donor site. All wounds were closed primarily and preservation of the accessory nerve to the superior fibres of the trapezius muscle enabled almost normal abduction of the arm. Conclusions: The anatomy and complications of the LTIMF are reviewed and certain recommendations are made to improve its reliability.
TEACHING NORMAL PHYSICAL EXAMINATION IN A LARGE‐GROUP INTERACTIVE USING ARTISTS’ MODELS
Authors: Hardman D. T. A. , Patel M. I. , Delbridge L. 
Published: January 2008

Background: The innovative use of artists’ models within the context of a large‐group interactive teaching session, at Royal North Shore Hospital is reviewed. Methods: The models were used to teach normal physical examination skills to a group of junior medical students, during their surgical rotation. This same group of students were also exposed to traditional bedside tutorials. The students evaluated both teaching experiences. Results: In the four areas of evaluation (interaction, explanation, presentation, and organization), the large‐group interactive sessions were consistently rated higher than the bedside tutorials (P < 0.001). Conclusions: The teaching technique is presented as an effective way of delivering quality clinical training to a group of junior medical students in an environment where access to good teaching material is becoming increasingly difficult.
COLORECTAL SURGERY IN THE ELDERLY: AN AUDIT OF SURGERY IN OCTOGENARIANS
Authors: Isbister William H. 
Published: January 2008

Background: Morbidity and mortality rates are higher in elderly compared to younger patients undergoing colorectal cancer surgery. This study was undertaken to see whether this finding applied to all colorectal surgery in the elderly and if so to try to identify the determining factors. Methods: All patients undergoing colorectal surgery between 1975 and 1990 were entered into a computerized database. Patients were divided into two groups, those less than 80 years (< 80) and those 80 years and more (80+), and compared with regard to the type of surgery performed, the patient's race, the seniority of the surgeon, the patient's disease, the operation performed and the postoperative morbidity and mortality. In addition, patients undergoing major resectional surgery and patients undergoing colorectal cancer surgery were compared separately. Results: Of 2011 admissions, 88 were for patients of 80+. The male to female admission rate was 1: 0.79 in the < 80 group and 1: 1.25 in the 80+ group. More surgical procedures were performed by consultants in older patients. More emergency admissions were for 80+ patients. Rectal, sigmoid and right colonic pathology was more common in the elderly. Very few elderly patients were admitted with minor anorectal problems. Rectal prolapse and colorectal cancer were the commonest causes for admission in octogenarians. There were more pulmonary and cardiovascular postoperative complications in 80+ patients. Urinary tract infections were also more common. The postoperative mortality rate was higher in older patients (7.9 vs 1.4%). Four hundred and sixty‐two patients underwent major resectional surgery and 45 were 80+. Surgery for diverticular disease was more frequent in younger patients (13.4 vs 2.2%) and cancer surgery in older patients (93.3 vs 70.5%). The postoperative mortality rate was higher in the elderly (11.1 vs 3.6%). Three hundred and thirty‐six major resections were for cancer and 42 were 80+. Emergency surgery was performed more commonly in the older group (38.1 vs 14.9%). The rate of advanced disease seemed to be similar in both groups. The postoperative death rate was higher in the elderly (11.9 vs 3.4%). Conclusions: Elderly patients were more likely to die from cardiopulmonary problems after surgical interventions than either from their primary disease or from the surgery undertaken for it. Good postoperative cardiopulmonary support should thus be provided for all such patients.
QUALITY OF LIFE AFTER BREAST CONSERVATION OR MASTECTOMY: A SYSTEMATIC REVIEW
Authors: Irwig Les , Bennetts Anna 
Published: January 2008

Background: For early breast cancer, survival after breast conservation is similar to that after mastectomy. Some women may not have a clear preference and wish to have further information about quality of life experienced after the alternative treatments. This paper describes a systematic review of randomized trials on mastectomy versus breast conservation for which there are data on quality of life or psyehosocial outcomes. Methods: Literature was reviewed to find all randomized controlled trials comparing breast conservation to mastectomy, with quality of life or psychological effects as an outcome. Studies were then critically appraised by two reviewers independently and any disagreements about their quality and results resolved by discussion. Results: A total of six randomized trials met our inclusion criteria. In general, they are of poor quality. Women who had breast conservation had a more favourable body image of themselves than those who had mastectomy in all five studies in which it was examined. The evidence was statistically inconclusive for all the other dimensions measured, namely perceptions of psychological health, sexual health, physical health, fear of the future and global quality of life. Radiotherapy may be a determinant of poorer psychological health and body image. Conclusions: Apart from body image, it is unclear whether breast conservation or mastectomy results in better psychosocial outcomes. Moreover, the studies were done before evidence was available to inform women about the equivalence of survival with these alternative treatments. Therefore there is inadequate information available to help many women decide about their choice of treatment in the future. Preference trials should be conducted, using standardized quality‐of‐life measures, in which women who are uncertain about which treatment to choose are randomized to breast conservation or mastectomy.
BREAST CANCER: AETIOLOGICAL FACTORS AND ASSOCIATIONS (A POSSIBLE PROTECTIVE ROLE OF PHYTOESTROGENS)
Authors: Stephens F. O. 
Published: January 2008

Background: In spite of many known and suspected factors associated with the risk of breast cancer there has until recently been no explanation for its continuing increase in women of Western societies over recent decades or why there has not been an equivalent increase in women of most Asian and other less Westernized societies. It has long been suspected that a significant factor has been an increasing change of diet in Western societies from one predominantly vegetarian to one with a high content of meat and dairy products as well as ‘refined’ foods. Although diet has long been suspected there has otherwise been no real explanation as to the mechanism of the change in incidence of breast cancer. Methods: A comprehensive literature review has been made of aetiological factors and associations concerning breast cancer to determine whether any consistent trend can explain the rising incidence in Western societies. Results: There are a number of likely contributory factors but there is now accumulating evidence that the single most important difference is that people having a vegetarian diet have a high intake of legumes and other plant foods containing a variety of lignans and isoflavonoids. These appear to have an important role as nature'sex hormone modulators. These agents appear to be biologically active in a number of ways not yet completely understood but they do have both a weak oestrogenic effect and an anti‐oestrogenic competitive effect, thus reducing the potential carcinogenic action of prolonged oestrogen activity. A probable additional benefit of such diets could be the role of dietary fibre. Conclusions: A major problem of Western diets may not be the presence of meat or dairy products in the diet but the absence of desirable ingredients of vegetarian diets, namely dietary fibre and certain plant lignans and isoflavonoids. A modification of diet to include a greater proportion of fibre and soy or other leguminous plant food should be studied. Alternatively addition of more fibre and lignans and especially isoflavonoids to traditional Western diets would seem worthy of serious investigation. Such influences appear to have their greatest impact early in life and therefore could be especially important for girls and young women in Western societies.
BREAST CANCER IN YOUNG WOMEN
Authors: Gillett David , Kennedy Catherine , Carmalt Hugh 
Published: January 2008

Background: It is believed that cancer of the breast is more difficult to diagnose in young women and it has long been disputed whether breast cancer occurring in women aged 40 years is more aggressive than that occurring later in life. A number of reports in the literature suggest that the disease is of similar aggressiveness in the young patients and older age groups, while other reports suggest that it is more aggressive and carries a higher mortality in young women. Methods: To address these aspects of breast cancer we have undertaken a review of the cases treated at The Strathfield Breast Centre between 1989 and 1996 and compared the disease in the young and old groups with particular reference to the modes of diagnosis, the pathological staging and types of tumour and the outcomes of treatment. Results: The accuracy of ultrasound and fine needle aspiration biopsy were similar in both groups, but the false negative rate of mammography in the young patients was 15% or 50% greater than that which was observed in the older patients. The incidence of histopathological type, bilaterality, size of lesion and receptor positivity were the same in both groups. In the young group, 40% had Grade 3 tumours compared with 27% in the older group. Nineteen per cent of young patients had 4 or more lymph nodes involved while only 10% of the older patients had similar lymph node involvement. Overall 5‐year survival was 79% in the older patients compared with 90% in the young patients. Conclusions: The spectrum of disease is similar in both the young and older patient and the prognosis is no worse for the young group but mammography is less effective in the diagnosis of the young patient.
PROSTATE CANCER MORTALITY IN NEW ZEALAND: THE PAST AND PROJECTIONS FOR THE FUTURE
Authors: Cohen Ronald J. , Robinson Elizabeth , McRae Colin U. 
Published: January 2008

Background: Ageing male populations and improved diagnosis of early stage disease have contributed to the increasing incidence of prostate cancer observed in many Western countries. The clinical significance of these diagnosed cancers is, however, currently unclear. The aim of this study is to examine trends over time in prostate cancer mortality as an indicative measure of clinically significant disease during a 29‐year period (1965–93) which preceded the extensive use of early cancer diagnostic techniques or radical therapy protocols. Methods: Age‐specific and age‐standardized rates were calculated for each year during the study period, using routinely collected mortality and demographic data. A Poisson regression model was used to describe trends in the age‐specific rates over time to predict numbers of prostate cancer deaths and the lifetime risk of death over the next 20 years. Results: Significant annual increases ranging from 1 to 2.6% were found for age‐specific prostate cancer mortality rates over the 29‐year time period, with the largest increases experienced in the younger age groups at risk. Based on projected population ageing and growth alone, annual numbers of prostate cancer deaths are predicted to increase from 487 in 1993 to 664 by the year 2006 and then to 833 by the year 2016. Continuation of the observed increases in age‐specific mortality rates would result in a predicted 797 deaths by the year 2006, while an expected 1115 deaths is calculated for the year 2016. This would correspond with an increase in the lifetime risk of death from prostate cancer from a present 3.7 to 4.5% in 10 years and 6.2% in 20 years. Conclusions: The changing pattern of prostate cancer mortality described in this study is likely to represent a significant increase in the incidence of clinically significant disease. This will have a significant impact on the ageing New Zealand male population, and important implications for the provision of effective treatment and preventive strategies.
PREVIOUS INTRAVENOUS CHEMOTHERAPY DOES NOT ALTER RESPONSE RATE OR SURVIVAL TIME OF PATIENTS WITH HEPATIC METASTASES FROM COLORECTAL CANCER TREATED BY HEPATIC ARTERY CHEMOTHERAPY
Authors: Morris David L. , Zhao Jing , Clingan Philip R. 
Published: January 2008

Background: The present paper addressed the issue of whether pretreatment with intravenous (IV) chemotherapy affects response rate or survival in patients receiving hepatic artery chemotherapy (HAC). Methods: Case note reviews of 164 patients treated in a teaching hospital from June 1990 to July 1996 were carried out. Results: The response rate and carcino‐embryonic antigen (CEA) fall in the two groups was almost identical. There was a nonsignificant survival advantage in the non‐pretreatment group. Conclusions: Previous administration of IV chemotherapy did not affect the CEA response of patients receiving HAC.
BENIGN ANTERIOR KNEE CYST IN EARLY CHILDHOOD
Authors: Liew S. M. , Menelaus M. B. 
Published: January 2008

Background: Anterolateral knee cysts are not uncommon in the first 7 years of life, but have not been described in the literature.Methods: Four patients presenting with an asymptomatic lump on the anterolateral joint line were reviewed.Results: The lump remains asymptomatic.Conclusions: Anterolateral knee cysts of childhood are benign and do not require treatment. Their cause is conjectural.