bluuebunny/crossref_metadata_2025_split huggingface dataset:
POSITIVE PROXIMAL RESECTION MARGINS AFTER RESECTION FOR CARCINOMA OF THE OESOPHAGUS AND STOMACH: EFFECT ON SURVIVAL AND SYMPTOM RECURRENCE
Authors: Gall C. A. , Rieger N. A. , Wattchow D. A. 
Published: January 2008

Background: Our aim was to determine the frequency, survival and symptomatic local recurrence rate of patients with a positive proximal resection margin in a series of patients having a resection for carcinoma of the oesophagus or stomach.Methods: A retrospective study of pathology reports and case notes. Survival and data on local recurrence were obtained from the patient or general practitioner.Results: Ten (11.5%) of 87 patients having a gastric or oesophageal resection for carcinoma had a positive proximal resection margin. All 10 patients underwent a palliative resection for late‐stage disease. Nine were dead at an average 8.3 months (range 2–20 months) post‐resection and one patient remains alive at 9 months. Only one of these 10 patients had evidence of a local recurrence with recurrent dysphagia prior to death at 11 months.Conclusion: A high incidence of a positive proximal resection margin was found. This occurred in patients who underwent a palliative resection for late‐stage disease, most of whom died before local recurrence became a problem. For patients recognized as having late‐stage disease, surgery for symptom palliation need not be aggressive (such as to include a thoracotomy) because achieving microscopic clearance is unlikely to affect the long‐term outcome.
AUSTRALIAN MULTICENTRE EVALUATION OF A NEW POLYURETHANE VASCULAR ACCESS GRAFT
Authors: Allen R. D. M. , Yuill E. , Nankivell B. J. , Francis D. M. A. 
Published: January 2008

Background: A new three‐layered cast polyurethane vascular access graft (Thoratec® VAG) is the most recent addition to the list of materials used in the search for the perfect prosthetic graft material for haemodialysis vascular access. Despite its use in 23 countries, a clinical assessment has not been published.Methods: An independent retrospective evaluation by questionnaire was obtained for 145 implantation procedures performed by 30 surgeons.Results: Ninety‐two per cent of procedures were performed for an acute need for vascular access and 73% had prior failed vascular access surgery. Patients were hospitalized for a median of 4 days and the graft was initially used at a median of 3 days. Median follow‐up was 306 days. Thoratec® VAG had a problem‐free (primary) patency of 44.9% and a functional (secondary) patency 64.5% at 1 year. Major causes of graft loss were thrombosis (17%) and infection (11%). Intra‐operative thrombosis was the only significant risk factor for subsequent thrombosis (P =0.013). Infection was less in patients with antibiotic prophylaxis that included vancomycin (P =0.02).Conclusion: The ability to use the graft soon after surgery is a major advance for patients who urgently need reliable medium to long‐term haemodialysis access.
BACTERIOLOGY OF NECROTIZING INFECTIONS OF SOFT TISSUES
Authors: Singh Gurpreet , Ray Pallab , Sinha Sunil K. , Adhikary Shailesh , Khanna Satish K. 
Published: January 2008

Background: Necrotizing infections of soft tissues (NIST) are being attributed to a large variety of organisms, besides the originally described β‐haemolytic Streptococcus. A detailed bacteriological study of these infections was thought worthwhile.Methods: A prospective study of 55 patients with NIST was carried out. Analysis of surface swabs and debrided tissue for aerobic and anaerobic bacteria and fungal infection was performed. A detailed bacteriological profile was obtained in 50 patients.Results: A total of 257 isolates (167 aerobic, 90 anaerobic) was obtained. One to nine strains of bacteria were isolated from each patient. Aerobic bacteria alone were isolated in 26 patients while the remaining patients grew both aerobic and anaerobic bacteria. Forty‐two patients had at least one Gram‐positive bacterium while 40 had at least one Gram‐negative bacterium. Staphylococcus aureus was the organism isolated most frequently (52%). followed by Bacteroides fragilis (40%) and anaerobic cocci (38%). Group A β‐haemolytic streptococci were isolated in 16%. Blood cultures were positive in only eight patients. Fungal cultures were positive in six patients. Aspergillus fumigatus was the commonest pathogen.Conclusions: Necrotizing infections of soft tissues are polymicrobial and no single bacterium is associated with a specific clinical entity. Importance should be placed on early recognition and treatment of the disease rather than on isolation of bacteria.
MAJOR UPPER GASTROINTESTINAL HAEMORRHAGE ASSOCIATED WITH HEPATIC ARTERIAL CHEMOPERFUSION
Authors: Ross William B. , Morris David L. , Clingan Philip R. 
Published: January 2008

Background: The present study reviews the nature of upper gastrointestinal complications of hepatic arterial chemoperfusion at a tertiary referral centre for the treatment of hepatic malignancy. Methods: The patients involved in the present study all had major upper gastrointestinal (GI) haemorrhage and were undergoing hepatic arterial chemoperfusion. Results: Eight patients had major upper GI haemorrhage. Three of these patients were not referred for surgical management, and all three patients died. The five patients who were admitted or transferred to our unit and who underwent surgery all survived. Conclusions: These complications are probably caused by extravasation of 5‐fluorouracil (5‐FU) following thrombosis of the gastroduodenal artery. The resulting cavity may perforate into the hepatic artery, portal vein, duodenum or biliary tree. Surgeons and oncologists should be aware of these complications. If upper abdominal pain occurs, chemoperfusion should cease immediately and an urgent investigation, which may include catheter angiography, gastroscopy and computed tomography (CT) scanning. should be carried out to exclude an hepatic artery pseudo‐aneurysm.
A SURVIVAL REGRESSION ANALYSIS OF PROGNOSTIC FACTORS IN COLORECTAL CANCER
Authors: D'Eredita Giovanni , Serio Gabriella , Neri Vincenzo , Polizzi Rosario A. , Barberio Giovanni , Losacco Tommaso 
Published: January 2008

Background: Many prognostic factors of colorectal cancer are known but their actual clinical validity is still uncertain. The aim of the present study was to verify, on the basis of our experience, the prognostic validy of variables for survival by using survival regression analysis.Methods: From January 1978 to December 1986 the prognostic factors for 192 patients were analysed. These patients had undergone surgical resection for colorectal cancer. The follow up was completed in every patient by the end of December 1992. with a median follow up of 10 years (range 6–14 years). The prognostic factors considered in the statistical analysis were age. sex, size of tumour, site, grade, direct spread, node involvement and stage (according to Astler‐Coller and pTNM).Results: Of the prognostic factors, sex was the only one not to show any prognostic significance. In the survival regression analysis we have used an accelerated failure time model (equivalent to the Cox proportional hazard model); age. grade and stage were significant covariables.Conclusions: Although clinical pathological staging (pTNM) appears as a pre‐eminent prognostic factor, and as our analysis shows. it needs a further variable (grading), which has been shown to affect the prognosis in a significant way.
IMMEDIATE BREAST RECONSTRUCTION IN CHINESE WOMEN USING THE TRANSVERSE RECTUS ABDOMlNlS MYOCUTANEOUS (TRAM) FLAP
Authors: Fung K. W. , Lau Y. , Nyunt K. , Chan C. M. , Ho C. M. 
Published: January 2008

Background: Total mastectomy remains the mainstay of operative treatment for breast cancer mainly because it is preferred by surgeons. The techniques and benefits of reconstructing the amputated breast have been well documented in the medical literature but there have been very few reports on this issue in Chinese women. Immediate breast reconstruction using the transverse rectus abdominis myocutaneous (TRAM) flap in Chinese women suffering from early breast cancer who require mastectomy is summarized.Methods: Since September 1991, the option of immediate breast reconstruction was offered to all patients less than 60 years of age suffering from early cancer (Tis, T1 or T2) who were not suitable for breast‐conserving treatment or who preferred to have a mastectomy. The single‐pedicled TRAM flap was used.Results: From September 1991 to September 1994, 27 reconstructions were performed. Partial flap loss occurred in four patients (15%). fat necrosis in three patients (11%) and abdominal bulging in one patient (4%). Operations performed by two teams simultaneously reduced operating time by 1.5 h without increasing the risk of complications. Twenty‐one patients (78%) were satisfied or very satisfied with the outcome of reconstruction.Conclusions: The TRAM flap is a safisfactory method of breast reconstruction in Chinese women. A two‐team approach can be employed safely to shorten operative time. Overall patient satisfaction was high.
TGF‐ALPHA IMMUNOREACTIVITY IN LARYNGEAL CARCINOMA: LACK OF PROGNOSTIC VALUE AND CORRELATION TO EGF‐RECEPTOR EXPRESSION
Authors: Lee C. Soon , Redshaw Anna , Boag Guy 
Published: January 2008

Background: Transforming growth factor alpha (TGF‐α) is a polypeptide that is structurally similar to epidermal growth factor (EGF) that binds to the epidermal growth factor receptor (EGFR) and has been implicated in the development of several types of human tumours. Methods: The expression of TGF‐α is examined in laryngeal squamous cell carcinoma (SCC) (n= 24) and non‐neoplastic polyps (n = 7) using streptavidin‐biotin immunohistochemistry and a monoclonal antibody to the TGF‐α protein. These cases had been previously characterized for EGFR immunoreactivity. The carcinomas were classified as well differentiated (n = 2). moderately differentiated (n = 16) and poorly differentiated (n= 6). Tissues from metastatic tumour deposits in lymph nodes (n = 5) were also studied. Results: TGF‐α overexpression was defined as intense immunoreactivity in more than two‐thirds of tumour cells immunostained for TGF‐a and was present in the majority of the SCC cases (n= 15; 63%) and metastatic turnour deposits (n = 4; 80%). In contrast, although some of the vocal cord polyps showed weak (n= 2) to moderate (n = 5) immunostaining, none had evidence of strong TGF‐a immunoreactivity. The differences in TGF‐α immunoreactivity were significant between primary laryngeal SCC and vocal cord polyps (P= 0.013; x2 test with continuity correction), and between metastatic laryngeal SCC and vocal cord polyps (P = 0.023; x2 test with continuity correction). There was no significant difference in TGF‐α expression between the different grades of carcinomas (P= 0.92, x2 test) or between non‐metastatic and metastatic carcinomas (P= 0.82; x2 test with continuity correction). No significant correlation was found between TGF‐α expression and patient survival or tumour recurrence (r = 0.077, r2= 0.006, P = 0.75; simple regression analysis), or between TGF‐α expression and EGFR immunoreactivity (r = 0.325. r'= 0.106, P = 0.0851). Conclusions: In conclusion, increased TGF‐α immunoreactivity is present in most cases of laryngeal SCC with no specific relationship to tumour grade, suggesting that it may be important in the development of laryngeal carcinomas but not in its progression. No significant correlation was found between TGF‐a and EGFR expression in laryngeal tumours and TGF‐a immunoreactivity is of no prognostic value.
A LONG‐TERM FOLLOW‐UP OF PATIENTS UNDERGOING COLECTOMY FOR CHRONIC IDIOPATHIC CONSTIPATION
Authors: Platell Cameron , Scache David , Mumme Geoff , Stitz Russell 
Published: January 2008

Background: Chronic idiopathic constipation is a condition that mainly affects young women and is commonly associated with symptoms of abdominal pain and bloating. It has been proposed that patients with severe symptoms who are unresponsive to conservative measures can be managed by colonic resection. The aim of the present study was to assess the long‐term outcome of such surgery on patients with a diagnosis of chronic idiopathic constipation.Methods: Ninety‐six patients (92 females, 4 males) underwent either a total colectomy and ileorectal anastomosis (n= 86) or subtotal colectomy and caecorectal anastomosis (n= 10) between 1986 and 1994.Results: Postoperative mortality was 2.1%, 3.1% suffered from an anastomotic leak and 11.5% developed a pelvic abscess. Follow up was completed in 92.7% of patients at a mean of 5.0 & 2.3 years. Following surgery, symptomatic improvement was reported by 81.6% of patients. However, 51.2% still experienced difficulty with straining, 50.6% had some degree of anal incontinence, 55.2% continued to experience abdominal pains and 75.9% continued to be troubled by abdominal bloating. Re‐operation was performed on 35.6% of patients (mainly for division of adhesions), and 9.2% of patients required an ileostomy.Conclusions: Colectomy is associated with relief of constipation in a majority of patients with chronic idiopathic constipation. However, it is associated with a considerable morbidity and is less effective in resolving symptoms of abdominal pain and bloating.
STEREOTACTIC FINE NEEDLE ASPIRATION IN THE MANAGEMENT OF MAMMOGRAPHIC ABNORMALITIES DETECTED IN BREAST SCREENING
Authors: Chan M. C. M. , Lam H. S. , Gwi E. , Leung T. Y. , Lau Y. , Yip W. C. 
Published: January 2008

Background: Fine needle aspiration (FNA) is used routinely in the management of palpable breast lumps; with the implementation of the stereotactic technique its use has been extended to the investigation of mammographic abnormalities. The advent of breast screening means that many mammographic abnormalities will be detected; because routine open biopsy is impractical and undesirable, stereotactic fine needle aspiration becomes the method of choice for investigation.Method: Within a 28 month interval, 81 Chinese women underwent stereotactic FNA in Kwong Wah Hospital, Hong Kong. Results: Fifty‐one women (62.9%) had a benign cytology result and no further investigations were required. Inconclusive results were obtained in 18.6% of the aspirates. Open biopsy was required in 16 women (19.8%).Conclusion: Stereotactic FNA is very useful in the exclusion of malignancy and the avoidance of open biopsy in asymptomatic women who have mammographic abnormalities.
A PROSPECTIVE STUDY ON THE USE OF WATER‐SOLUBLE CONTRAST FOLLOW‐THROUGH RADIOLOGY IN THE MANAGEMENT OF SMALL BOWEL OBSTRUCTION
Authors: Chung C. C. , Meng W. C. S. , Yu S. C. H. , Leung K. L. , Lau W. Y. , Li A. K. C. 
Published: January 2008

Background: The purpose of this prospective study was to determine the value of water‐soluble contrast follow‐through radiology in predicting the outcome in patients with small bowel obstruction.Methods: Patients with clinical and radiological evidence of small bowel obstruction were selected according to pre‐set criteria. A water‐soluble contrast follow‐through examination using 76% urografin was carried out within 24 h of hospital admission. The result was interpreted as ‘significant obstruction’ if the contrast failed to reach the caecum in 4 h or if there was a clear cut‐off in the gastrointestinal tract. The result was interpreted as ‘insignificant obstruction’ if the contrast reached the caecum within 4 h. The surgeon was blinded to the result of the contrast examination in the patient management, and the decision to operate was based entirely on conventional clinical grounds.Results: Fifty‐one patients in an 18 month period underwent the contrast examinations. Thirty‐four patients (67%) had had previous abdominal operations. The results showed that significantly more patients who had ‘significant obstruction’ on contrast radiology required surgery to relieve the intestinal obstruction (17/19) than those who had ‘insignificant obstruction’ (1/32; Fisher's exact test, P < 0.0001). This difference was found to be significant in both patient subgroups: patients with or without previous abdominal operation. There was no major morbidity or mortality related to the contrast radiology procedure.Conclusions: Urografin follow‐through examination is a safe procedure; using 4 h as the cut‐off it is highly predictive of the outcome in small bowel obstruction in patients with or without previous abdominal operation.
NEUROSURGERY IN PAPUA NEW GUINEA
Authors: Rosenfeld Jeffrey V. , Watters David A. K. , Jacob Olapallil J. 
Published: January 2008

Background: An audit of neurosurgery in Papua New Guinea (PNG) based on the experience of a visiting neurosurgeon is presented. The objectives of the study were to determine the type and frequency of neurosurgical conditions in PNG, whether major neurosurgery can be performed successfully in PNG, and to develop a strategy for the development of neurosurgical services in PNG.Methods: The audit was carried out over two periods of 2 weeks duration in 1992 and 1993 in Port Moresby and Goroka. Instrumentation and equipment were limited and no additional equipment was used. Myelography and angiography were available in Port Moresby.Results: There were 82 patients in total, 55 (67.1%) were consultations, 23 (28%) had elective surgery, four (4.8%) had emergency surgery and 16 (19.5%) await surgery. Cases were subdivided into nine major groupings: neurotrauma 18 (seven severe); spine 18; congenital 13; hydrancephaly four; scalp, skull and orbit six; vascular three; peripheral nerve three; and neurology five. Seventy‐two (87.8%) patients required CT/MRI which were unavailable. Four ventriculograms were performed in lieu of CT/MRI. Fifteen (18.3%) cases could not be treated in PNG.Conclusions: Neurosurgical problems in PNG can often be adequately managed with limited resources. Complex procedures were performed with gratifying results and acceptable morbidity. There is sufficient pathology in a country of four million people to justify training a small number of neurosurgeons by the end of the decade. CT scanning will be a necessary adjunct.
MAMMOGRAPHICALLY NEGATIVE BREAST CANCER AT THE STRATHFIELD BREAST CENTRE
Authors: Chew Sun‐Beng , Hughes Michael , Kennedy Catherine , Gillett David , Carmalt Hugh 
Published: January 2008

Background: The current diagnostic modalities used to detect breast cancer are mammography, together with clinical examination, ultrasound and fine needle aspiration biopsy (FNAB). The accuracy rates for each modality varies and a combination of the modalities is recommended to detect cancer early. Some authors have suggested that mammography should be used primarily as a screening tool because of the false negative mammography results that have been reported in the past 10 years. The records of patients at the Strathfield Breast Centre were reviewed to determine the accuracy of the practice and to compare it with the accuracy of other modalities.Methods: The records of 371 breast cancer patients treated at the Strathfield Breast Centre in the 6 years from 1989 to 1994 were reviewed to determine the accuracy of mammography, ultrasound, clinical examination and fine needle aspiration biopsy. Of the 371 women with histopathologically diagnosed breast cancer, 349 had mammography.Results: The accuracy rate of mammography in the present study was 91% with a false negative rate of 9%. It was found that there was no significant delay in the treatment of breast cancer in mammogram‐negative patients.Conclusions: Mammographically negative breast cancer was found to be more common in younger women, to be similar in size to mammogram‐positive cancer, to occur in all histological types and grades and was usually invasive rather than noninvasive. The rate of lymph node involvement was similar to the mammogram‐positive group.
BILIARY COMPLICATIONS AFTER LIVER TRANSPLANT: THE VICTORIAN EXPERIENCE
Authors: Hardy Kenneth John , Wang Bao‐Zhon C. , Jones Robert McLaren 
Published: January 2008

Background: Biliary complications remain a continuing problem in liver transplantation. The goals of this study were to document the frequency of biliary complications following orthotopic liver transplantation in the Victorian programme. and to examine associations with suspected risk factors with reference to biliary stenosis.Methods: Data were collected from 129 consecutive transplants in 123 patients (106 adults, 17 children) at the Austin Hospital, Melbourne during the period 1988–94. The 2 year actuarial survival was 88%. Biliary reconstruction was by end‐to‐end anastomosis in 89 patients and Roux‐en‐Y in 40. Complications were suspected on clinical, biochemical or microbiological evidence. Biliary stenoses were considered to be radiological evidence of duct narrowing.Results: Biliary complications occurred in 19% and biliary stenosis in 8.5%. Of the stenoses, 1/35 occurred in the first 20 month period, 9/47 in the second and 1/47 in the third. There was a significant difference between the middle period and other periods (P< 0.05, Chi‐square test). This change may be related to incomplete flushing of bile from the donor liver. Recurrence of the original disease was suspected for one stenosis. The length of the donor bile duct from hilum to anastomosis, cold ischaemia time and total hepatic artery flow at transplant did not relate to stenosis. Cholangitis was not diagnosed in patients without strictures. Strictures were managed by dilatation (5/11) and by operative repair (6).Conclusions: Stenoses were not related to the length of the donor bile duct, cold ischaemia time or total hepatic artery flow. Meticulous adherence to the protocol for flushing out bile at the donor operation was associated with a significant reduction in frequency of biliary stenoses.
HEPATIC CYSTIC DISEASE IN AN ADULT POLYCYSTIC KIDNEY DISEASE TRANSPLANT POPULATION
Authors: Harris R. A. , Gray D. W. R. , Britton B. J. , Toogood G. J. , Morris P. J. 
Published: January 2008

Background: A study of the incidence of polycystic liver in a transplant population and an assessment of the impact of this disease on the group was undertaken. Clinical presentation, investigation and treatment of hepatic polycystic disease are explored.Methods: The study examined the morbidity incurred by polycystic liver disease in these patients, patient and graft survival, incidence of hepatic cysts and presentation, investigation and management of morbid hepatic cystic disease. One hundred and eleven patients were studied.Results: It was found that hepatic cysts occurred in the majority of patients that underwent transplants for renal failure because of polycystic kidney disease at this institution. Symptomatic hepatic cystic disease was found to be primarily responsible for three deaths and affected between 15 and 20% of the group. Gall bladder disease was found to be associated with highly symptomatic hepatic cystic disease.Conclusion: Hepatic cystic disease is common in patients that have had kidney transplants because of polycystic kidney disease. Morbidity is likely to increase as patients survive for longer periods. Cholecystectomy should be considered in patients with significant hepatic cystic disease.