bluuebunny/crossref_metadata_2025_split huggingface dataset:
COSTING TRANSURETHRAL RESECTION OF THE PROSTATE AND DIAGNOSIS RELATED GROUP IN AUSTRALIA COMPARED WITH UNITED STATES COSTS
Authors: Gordon Neil S. I. 
Published: January 2008

The cost of a transurethral resection of the prostate is of considerable concern to the community. More of these procedures are being performed as the number of patients in the aged population increases.The costs of wages and salaries, purchase of equipment and depreciation, stationery, linen, investigations (pathology) and pharmaceuticals are compared with the bed charges (as charged to a private patient), the cost per inpatient day and the cost per inpatient treated, which is calculated from the operating fund budget expenditure of The Bendigo Hospital.The cost per diagnosis related group (DRG) 336 (defined as: transurethral prostatectomy, age greater than 69 and/or complication/co‐morbidity; mean length of stay 7.0 relative weight = 0.9869) and DRG 337 (defined as: transurethral prostatectomy, age less than 70 without complication/co‐morbidity; mean length of stay 5.8; relative weight = 0.7788) are compared with the figures for a similar procedure in 1987 in a United States hospital and extrapolated, by the use of the Consumer Price Index, to 1992 levels.The findings demonstrate that transurethral resection of the prostate as costed in this hospital compares very favourably with that in a US hospital, and favourably from the point of view of health care costs.
EPIDEMIOLOGY OF CHRONIC LEG ULCERS IN AUSTRALIA
Authors: Baker Stephen R. , Stacey Michael C. 
Published: January 2008

The aim of this study was to determine the point prevalence of ulceration of the leg in an Australian community. This was a population‐based epidemiological study. Two hundred and fifty‐nine patients with leg ulceration were identified by health care professionals of all types working in hospitals and private practices, as well as by self referral from patients. The base population in the study area was 238000. The following data were recorded: age, sex, site of ulceration. duration of ulceration, history of previous ulceration and patient mobility.The point prevalence was 0.11%. The male: female ratio was 1:1.9; however the age related prevalence was similar for both sexes. The age related prevalence of ulceration was similar to that found in two similarly conducted studies in the United Kingdom. The ulcers were a chronic problem with 24% having been present for more than 1 year. Thirty‐five per cent of patients had had a problem of ulceration for more than 5 years and 20% had suffered 10 or more episodes of ulceration. Related immobility was a prominent factor with 45% of patients being housebound. Chronic ulceration of the leg is a common recurrent problem in the elderly population and is likely to increase as the population grows. There is a definite need to improve the method of treating this problem.
SURGICAL RESEARCH: THE ROLE OF THE KIDNEY IN THE CLEARANCE OF CALCITONIN GENE RELATED PEPTIDE (CGRP)
Authors: Rubinstein C. , Fletcher D. R. , Shulkes A. , Hardy K. J. 
Published: January 2008

Calcitonin gene‐related peptide (CGRP) is a 37 amino‐acid peptide. undetectable in the plasma in health but elevated in certain disease states such as medullary thyroid cancer, and potentially causes symptoms. The kidney is a major site of and influence on the clearance of exogenously infused CGRP. As CGRP might cause symptoms in renal dysfunction, this study was performed to determine the clearance of CGRP in humans and animals with altered renal function.In chronic renal failure patients, CGRP was not detected in plasma either before or after haemodialysis. In sheep, before and after bilateral nephrectomy, there was an approximate halving of plasma clearance and doubling of the circulating half‐life of infused CGRP. This reduction in clearance was greater than that which could be accounted for by the reduction in degradation by renal substance alone. This renal influence on extra‐renal CGRP metabolism was not due to the renal production of a circulating peptidase as evidenced by the absence of such peptidase in the plasma of normal and anephric sheep. Further, seventy of uraemia had no influence on the extra‐renal metabolism. The mechanism by which the kidney influences the extra‐renal metabolism of CGRP remains obscure.
THE TREATMENT OF CHILDHOOD PHIMOSIS WITH TOPICAL STEROID
Authors: Wright J. E. 
Published: January 2008

A prospective study of the efficacy of topical steroid in the treatment of childhood phimosis is reported. Boys referred to a paediatric surgical practice with pathological non‐retractable foreskins were treated for at least 1 month with topical beta methasone cream.One hundred and thirty‐nine patients were treated and 111 completed the study. A satisfactory result, defined as foreskin retractability appropriate for the boys' age, was achieved in 80% of patients. In 10% the response was inadequate at the end of the study period, but these boys were still under treatment or surveillance because their parents declined circumcision. In 10%, circumcision was performed because of failure of treatment. In six patients this was due to balanitis xerotica obliterans (lichen sclerosis et atrophicus) which does not respond to conservative treatment.Successful treatment depends upon the presence of a normal, supple foreskin at the outset, and on parental compliance.
BONE ALLOGRAFT BANKING IN SOUTH AUSTRALIA
Authors: Campbell D. G. , Oakeshott R. D. 
Published: January 2008

The South Australian Bone Bank has expanded to meet an increased demand for allograft bone. During a 5 year period from 1988 to 1992, 2361 allografts were harvested from 2146 living donors and 30 cadaveric donors. The allografts were screened by contemporary banking techniques which include a social history, donor serum tests for HIV‐1, HIV‐2, hepatitis B and C, syphilis serology, graft microbiology and histology. Grafts were irradiated with 25 kGy.The majority of grafts were used for arthroplasty or spinal surgery and 99 were used for tumour reconstruction. Of the donated grafts 336 were rejected by the bank. One donor was HIV‐positive and two had false positive screens. There were seven donors with positive serology for hepatitis B, eight for hepatitis C and nine for syphilis. Twenty‐seven grafts had positive cultures.Bone transplantation is the most frequent non‐haematogenous allograft in South Australia and probably nationally. The low incidence of infectious viral disease in the donor population combined with an aggressive discard policy has ensured relative safety of the grafts. The frequency of graft rejection was similar to other bone banks but the incidence of HIV was lower.
V‐Y ADVANCEMENT HAMSTRING MYOCUTANEOUS ISLAND FLAP REPAIR OF ISCHIAL PRESSURE ULCERS
Authors: Cope C. , Barry P. , Hassall M. , Barnett R. , Richards M. , Vandervord J. 
Published: January 2008

Thirty‐seven ischial pressure ulcers were repaired in 27 patients (eight quadriplegic, 19 paraplegic) between 1988–1993 using the V‐Y advancement hamstring myocutaneous island flap. Twenty‐one ulcers (57%) arose de now and 16 were recurrent, with five patients having bilateral ulcers. The average duration of the ulcer was 5 months (range 1–30). All ulcers extended through the deep fascia (clinical grade IV), with the average diameter being 4.7 cm (range 2–10). There were four major flap complications (11%). All but one of the ulcers healed at discharge (97%). Mean follow up was 20 months (range 5–54) in 21 patients (78%), with six patients being lost to follow up. Seven of the 21 (33%) patients developed recurrent ulcers, with four of these having flap re‐advancement with successful healing, and one patient having two re‐advancements. Overall, 18 of the 21 (86%) patients with follow up had healed ulcers at time of follow up.The V‐Y advancement hamstring myocutaneous island flap is versatile, reliable, easy to perform, has few complications, and can be re‐advanced in the event of recurrence.
DEVELOPMENT OF A STAPHYLOCOCCUS EPIDERMIDIS VASCULAR GRAFT INFECTION MODEL IN SHEEP
Authors: Sardelic F. , Peng Y. A. , Fletcher J. P. 
Published: January 2008

Staphylococcus epidermidis is an increasingly recognized causative organism of vascular graft infections. To increase our understanding of this problem we have tried to establish Staph. epidermidis vascular graft infection in sheep by direct inoculation.A 2 cm long, 5 mm diameter polytetrafluoroethylene (PTFE) or a gelatin sealed Dacron vascular graft was inserted into the left carotid artery, At the completion of the operation 1 mL of normal saline containing either 104, 106, or 108 colony forming units (cfu) of a slime producing Staph. epidermidis was inoculated directly onto the graft. After 3 weeks the grafts were harvested in a sterile fashion. Swabs were taken of the perigraft tissues and the external and internal aspects of the grafts; a 3–5 mm segment of the graft was incubated in broth medium and a second segment was ground for 5 min and then incubated in broth medium. Note was made of the presence of abscess formation, anastomotic failure or thrombosis.Thirteen sheep received a PTFE graft and 14 received a gelatin sealed Dacron graft. Three sheep died immediately postoperatively. The rate of infection was 40% at 104. 67% at 106 and 80% at 108 cfu Staph. epidermidis. In only four cases were all five cultures positive. In nine cases two or less cultures were positive, the majority of these being the broth cultures. Nine other organisms were isolated from nine mixed infections. Nine out of 13 PTFE and seven out of 11 Dacron grafts were infected.The rate of graft infection grew with increasing concentration of inoculum. Retrieval of bacteria was greatest when the graft was cultured directly, especially with physical disruption. Infection with additional organisms was common. There was no difference in the infection rate between gelatin sealed Dacron and PTFE.
MINIMAL ACCESS SURGERY OF THE GASTROINTESTINAL TRACT
Authors: Toouli James , Cox Michael R. 
Published: January 2008

In the last 5 years, surgery of the gastrointestinal tract has been revolutionized by the application of minimal access techniques. Following initial enthusiasm, which suggested that most abdominal surgery would ultimately be done via this approach, there is now need for appraisal and evaluation of the role of a number of these minimal access techniques when compared with open surgery.Undoubtedly, the most convincing and total application of minimal access techniques has been in the treatment of gallstone disease. Laparoscopic cholecystectomy is now standard therapy for cholelithiasis and endoscopic sphincterotomy with stone extraction is standard therapy for choledocholithiasis. Where the two conditions co‐exist, operative cholangiography allows for the recognition of stones in the bile duct at the time of laparoscopic cholecystectorny and provides the potential avenue for treatment. Most major centres also would recommend routine operative cholangiography during laparoscopic cholecystectomy for the detection of unsuspected stones and as an extra safety procedure in the early identification of potential bile duct injuries.The efficacy of laparoscopic appendicectomy and laparoscopic or thoracoscopic treatment of achalasia of the oesophagus also is supported by data from well conducted prospective studies.Doubt remains regarding the advantage of laparoscopic surgery over other approaches in the treatment of gastro‐oesophageal reflux, inguinal hernias and jaundice due to non‐resectable cancer. For all three of these conditions, prospective trials are underway and the results of these trials should be assessed prior to widespread adoption of the laparoscopic techniques.The application of minimal access surgery for colorectal procedures, peptic ulcer therapy, liver and pancreatic surgery or surgery of the spleen and adrenal has been demonstrated; however, its ultimate place awaits the further development of instruments and a demonstration of efficacy over open approaches before it can be recommended for use in prospectively conducted comparison trials.
THE SURGICAL TREATMENT OF BRACHIAL PLEXUS INJURIES
Authors: Tonkin M. A. , Eckersley J. R. T. , Gschwind C. R. 
Published: January 2008

Background: Brachial plexus injuries cause a devastating loss of function in the arm. The aim of this study was to review the results of surgical treatment of patients with brachial plexus injuries.Methods: Forty‐seven patients were reviewed. Five patients did not undergo surgery. Forty‐two patients had exploration and 38 had primary surgery with neurolysis, nerve graft or neurotization or a combination. Four patients had other reconstructive surgery primarily. Secondary reconstructive surgery consisted of joint fusions and tendon transfers to enhance or replace the primary surgery.Results: Nerve grafting achieved 62% Medical Research Council (MRC) grade M3 or better. Intercostal neurotization (ICN) of the musculocutaneous nerve (MCN) for elbow flexion achieved M3 or better in 69% of patients.Conclusions: Primary nerve reconstruction, combined with joint fusions and tendon transfers, provides a worthwhile return of function to many patients. We advise early exploration (i. e. within 2 weeks when possible) for patients with complete C5‐T1 lesions or C5, 6, 7 lesions in conjunction with high energy injuries. In order to obtain optimal results patients with brachial plexus injuries should be referred to appropriate units as early as possible.
SURGICAL CONSIDERATIONS IN THE HARTMANN'S PROCEDURE
Authors: Chua C. L. 
Published: January 2008

Background: The present study examines the surgical outcome of the Hartmann's and Hartmann‐type procedures, the problems with the remnant rectal stump and the issues related to the colorectal anastomosis as well as the differences in patient outcome. Methods: One hundred and five consecutive patients (mean age 66) were evaluated. Surgical morbidity and mortality were analysed with regard to the colorectal pathology and the type of rectal stump remnant. The surviving patients were reviewed according to whether they had second‐stage anastomosis.Results: In 65% of cases there were obstructed or perforated malignancies and in 16% complicated diverticular diseases. The peri‐operative mortality and morbidity were 11.4% and 24%. respectively. Seventy‐two patients had intraperitoneal rectal stumps and stump blowout occurred in three intraperitoneal and one extraperitoneal remnant stumps. Local tumour recurrence (four) and diversion proctitis (three) were diagnosed in the rectal stump among asymptomatic patients. When the second‐stage reversal of Hartmann's procedure was considered (35 cases), twice as many were performed for diverticular and other benign conditions as for tumour cases.Conclusions: Although there is a good anatomical basis for advocating extraperitoneal rather than intraperitoneal stumps, in practice the stump blowout rate is not statistically significant (3%vs 4.1%). However, the chances of regaining normal rectal function are much better for benign disease (68%vs 32%—Fisher's exact test, P= 0.004). Complications from second‐stage re‐anastomosis are not determined by timing of the closure, provided the septic episode has subsided.
BIZARRE PAROSTEAL OSTEOCHONDROMATOUS PROLIFERATION: A REVIEW OF SEVEN CASES
Authors: Smith N. C. , Ellis A. M. , McCarthy S. , McNaught P. 
Published: January 2008

Background: Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare tumour‐like condition mostly affecting the tubular bones of the hands and feet. Although it recurs in 50% of cases after local excision, it is a form of heterotopic ossification and its behaviour is otherwise benign. The present study describes seven cases of BPOP collected by the Bone Tumour Registry of New South Wales.Methods: Clinical data, radiographs and histological specimens collected by the Bone Tumour Registry of New South Wales were examined, and further clinical data were sought from the referring doctor where necessary.Results: Six males and one female aged 18 to 37 years (median 30 years) presented between 1988 and 1995. There were three cases involving the hands, three involving the feet and one involving the distal humerus. Initial treatment was by local excision in all cases. There was local recurrence in three cases. The initial diagnosis was wrong in five of the seven cases. Radiologically, BPOP appears as a well‐defined tumour arising directly from the bony cortex, without periosteal reaction or change to the underlying bone. Histologically, a large amount of hypercellular cartilage shows maturation to trabecular bone, which frequently contains spindle cells in the intertrabecular spaces.Conclusion: BPOP is a rare, locally recurrent but otherwise benign condition of bone which must be distinguished from more sinister lesions such as parosteal osteosarcoma and chondrosarcoma.
DIFFERENCES IN PATTERNS OF CARE OF PROSTATE CANCER, NEW SOUTH WALES, 1991
Authors: McCredie Margaret , Bell Jane , Lee Alice , Rogers John 
Published: January 2008

Background: In this time of uncertainty about the benefits of earlier diagnosis for prostate cancer and the optimal choice of treatment in various clinical scenarios, we addressed the hypothesis that two groups in the population, namely country dwellers and migrants from non‐English‐speaking countries, were less likely to be offered new methods of diagnosis and treatment for prostate cancer.Methods: Incident cases of prostate cancer in 1991 were identified through the population‐based New South Wales Central Cancer Registry. For 73% of eligible cases information relating to diagnosis, staging and treatment was abstracted onto a checklist from clinical records in urologists' consulting rooms and in public hospitals.Results: Transrectal ultrasound and prostatic biopsy were used for diagnosis significantly more often in urban than in rural cases while the reverse was true for transurethral resection of the prostate. Intravenous pyelography, ultrasound (other than transrectal) and bone scans were performed for staging more frequently in urban than rural cases. Rural cases were more likely to be treated with anti‐androgens than urban cases and less likely to be given luteinizing‐hormone releasing hormone (LH‐RH) agonists. The pattern of use of various diagnostic and staging procedures for 1991 rural cases resembled that for urban men diagnosed with prostate cancer in 1986 rather than that for 1991 urban cases.Conclusions: At least in part, these urban‐rural differences could be explained by the fact that some patients in the country would have been treated by general surgeons rather than urologists. The patterns of care for non‐English‐speaking migrants resembled those for the Australian‐born and for English‐speaking migrants.
THIRTY YEARS EXPERIENCE WITH HEART VALVE SURGERY: ISOLATED MITRAL VALVE REPLACEMENT
Authors: Bessell Justin R. , Gower Georgina , Craddock David R. , Stubberfield John , Maddern Guy J. 
Published: January 2008

Background: Thirty years have elapsed since the commencement of open‐heart surgery in South Australia. A retrospective study was performed to evaluate mortality and complication rates and to identify factors associated with poor outcomes in all patients who underwent prosthetic mitral valve replacement during this period. Methods: Questionnaires and personal contact have been used to generate a combined database of pre‐operative and postoperative information and long‐term follow‐up on 938 patients who underwent isolated prosthetic mitral valve replacement at the Cardio‐Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1993. Results: Complete survival follow‐up data were obtained for 92% (865) of the patients. The Starr‐Edwards valve was used in 95% (891) of the patients, a Bjork‐Shiley prosthesis in 2.5% (23) of the patients, and only 24 (2.5%) other valves were inserted. The hospital mortality rate for the 30‐year period was 4.7%. The mean age of the patients who underwent surgery was greater in each of the three successive decades. A long‐term survival advantage was observed for patients with mitral stenosis, however, survival was significantly shorter for patients with higher New York Heart Association (NYHA) functional classifications and for patients in pre‐operative atrial fibrillation. Pre‐operative dyspnoea was significantly improved following mitral valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series. Conclusion: Mitral valve recipients do not regain a normalized life expectancy, but risk factors that determine long‐term survival can be identified pre‐operatively to aid appropriate patient selection.
MORBIDITY AND MORTALITY AFTER SINGLE‐ AND DOUBLE‐STAPLED COLORECTAL ANASTOMOSES IN PATIENTS WITH CARCINOMA OF THE RECTUM
Authors: Moore J. W. E. , Chapuis P. H. , Bokey E. L. 
Published: January 2008

Background: The optimal method of restoring intestinal continuity after rectal resection has been controversial. This study aims to compare the morbidity, mortality and survival of patients having either single‐stapled (SS) or double‐stapled (DS) colorectal anastomoses following resection of the rectum for cancer. Methods: Peri‐operative and long‐term follow‐up data were prospectively documented in all patients undergoing rectal resection for carcinoma with a stapled anastomosis at our institution over a 14‐year period. Patients were stratified by anastomotic technique (SS or DS). Peri‐operative mortality, complications potentially related to anastomotic technique and cancer‐related outcome were compared. Results: Two hundred and thirty‐five patients had SS and 65 patients had DS anastomoses. The groups were well matched for age, sex, and tumour stage. Double‐stapled anastomoses were used more frequently in the distal third of the rectum (P < 0.001). The distal margin of resection was not influenced by anastomotic technique. Major anastomotic leakage in 2.9% of SS cases was not significantly different from 6.1% of DS cases, and leakage was not influenced by anastomotic technique at any given level of the rectum. Two‐year local recurrence rates were not significantly different between groups (SS 3.5%: DS 5.9%). Conclusions: These results suggest that the double‐stapling technique is as safe as the single‐stapling technique for constructing an anastomosis after excision of the rectum for cancer, in terms of the risk of leakage, the development of an anastomotic stricture. or local recurrence.
VESICO‐URETERIC REFLUX AND SURGICALLY TREATED PELVI‐URETERIC JUNCTION OBSTRUCTION IN INFANTS UNDER THE AGE OF 12 MONTHS
Authors: Woo Henry H. , Farnsworth Robert H. 
Published: January 2008

Background: Pelvi‐ureteric junction obstruction has been increasingly diagnosed in infants, mostly as a consequence of antenatal ultrasound examinations. Methods: Of 55 infants below the age of 12 months who underwent dismembered pyeloplasty over a 7‐year period, we aimed to determine the patterns and outcome of associated vesico‐ureteric reflux that was present in 15 (28%) of the 53 infants in whom follow‐up was available. Results: A total of eight infants had resolution of their reflux with conservative management and the median time to resolution was 15 months. Five infants proceeded to ureteroneocystotomy. Conclusions: Given the association of vesico‐ureteric reflux and pelvi‐ureteric junction obstruction, routine cystography is recommended when the diagnosis of pelvi‐ureteric junction obstruction is made.