bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimal invasive surgery for hip replacement: a new technique using the NILNAV hip system
Authors: Sherry Eugene , Egan Michael , Warnke Patrick H. , Henderson Antony , Eslick Guy D. 
Published: December 2004

Background:  Minimal invasive surgical techniques are used for cruciate ligament reconstructions, unicondylar knee replacements and, more recently, for fixation of fractures. This is a report of the first instrumented technique for hip replacement using a 5‐cm incision without the need for a navigation system or X‐rays.Methods:  It uses the C.F.P stem (LINK) but is universal. It includes jigs for the osteotomy of the neck, a right‐angled reamer and spacers (lollipops) to orientate the acetabular cup to the femoral stem. A case series of 14 patients using this new hip replacement technique (called NILNAV Hip System) is reported.Results:  The procedure was successfully performed on all seven patients, with reduced postoperative pain and stiffness, and increased quality of life and functional status. All patients were discharged on postoperative Days 1 and 2 with minimal pain and blood loss.Conclusions:  This new minimal access total hip replacement technique was successfully performed on seven patients. There are several advantages of using this system compared with the more traditional techniques. Such a technique should help reduce morbidity and mortality rates for those patients undergoing a total hip replacement.
Management of gallstone pancreatitis in Auckland: Progress and compliance
Authors: Ong Soo‐Kim , Christie Peter M. , Windsor John A. 
Published: December 2004

Background:  Recent advances in the management of acute gallstonepancreatitis include the introduction of laparoscopic cholecystectomy,defining the role of endoscopic retrograde cholangiopancreatography(ERCP) and early cholecystectomy to prevent recurrent pancreatitis.The aim of the present study was to review the current managementof gallstone pancreatitis in Auckland Hospital, compare findingswith a similar study published a decade ago and to determine theextent to which the management is compliant with recently publishedconsensus guidelines.Methods:  A retrospective review of consecutive patients admittedwith acute pancreatitis during a 39‐month study period was undertaken.Data were recorded regarding demographics, diagnosis, predictedand actual severity of gallstone pancreatitis (index and recurrentattacks), the role of ERCP and computed tomography scanning, thetiming of cholecystectomy (open and laparoscopic), intraoperativecholangiography, duration of hospital stay, complications and mortality.Results : There were 216 patients admitted with acute pancreatitis,106 of whom had proven gallstones. An ERCP was performed in 62(59%) patients with gallstone pancreatitis but not morecommonly in patients with severe pancreatitis, and common bile duct stoneswere identified in 26% of these patients. Of the 70 (66%)patients who had a cholecystectomy, 56 (80%) had it within3 weeks of admission. Although the proportion of patientswith gallstone pancreatitis who had a cholecystectomy is similarto the earlier study, there has been a significant increase in theproportion of patients having a cholecystectomy during the indexadmission (χ2 = 3.83; P = 0.05).This has resulted in a reduction in recurrent pancreatitis (P < 0.001).Although the overall mortality from gallstone pancreatitis has notsignificantly decreased, it has for patients with predicted severegallstone pancreatitis (P = 0.02).Conclusion : There has been reasonable compliance with publishedguidelines and some progress in the management of gallstone pancreatitis,particularly in relation to performing timely laparoscopic cholecystectomywith a reduction in the incidence of recurrent pancreatitis. Concernsremain regarding the overuse of diagnostic ERCP in patients withmild pancreatitis.
Comparison of ankle‐brachial pressure index measurements using an automated oscillometric device with the standard doppler ultrasound technique
Authors: Ramanathan Anantha , Conaghan Philip J. , Jenkinson Andrew D. , Bishop Christopher R. 
Published: December 2004

Background:  The aim of the present study was to assess the accuracy of an automated oscillometric device (DINAMAP) in measuring ankle‐brachial pressure index (ABPI) in the clinical setting. Results were then compared to those obtained using the standard Doppler technique.Methods:  A prospective comparative study of 50 healthy volunteers was carried out using a standard ward DINAMAP machine, hand‐held Doppler and a 14 cm sphygmomanometer cuff. Three consecutive pressure readings were taken from all four limbs of the volunteers using both Doppler and DINAMAP techniques. The two techniques were carried out by different investigators who were blind to the findings of the other. The ABPI was calculated for each technique and the two techniques were compared.Results:  There was no significant agreement between the ABPI readings obtained by DINAMAP and those obtained by the standard Doppler technique. There was also a substantial variation in pressure readings produced by the DINAMAP for a given limb as measured by intraclass correlation of the three readings taken.Conclusions:  There is no role for standard automated oscillometric devices in the calculation of ABPI in the vascular clinic.
The Keystone Design Perforator Island Flap in reconstructive surgery
Authors: Behan Felix C. 
Published: December 2004

Background:  A surgical technique for closing skin defects following skin cancer (particularly melanoma) removal is described in the present paper. Its use is illustrated in five patients. The technique has been used in 300 cases over the past 7 years and is suitable for all areas of the body from scalp to foot.We have coined the term Keystone Design Perforator Island Flap (KDPIF) because of its curvilinear shaped trapezoidal design borrowed from architectural terminology. It is essentially elliptical in shape with its long axis adjacent to the long axis of the defect. The flap is based on randomly located vascular perforators. The wound is closed directly, the mid‐line area is the line of maximum tension and by V‐Y advancement of each end of the flap, the ‘islanded’ flap fills the defect. This allows the secondary defect on the opposite side to be closed, exploiting the mobility of the adjacent surrounding tissue. The importance of blunt dissection is emphasized in raising these perforator island flaps as it preserves the vascular integrity of the musculocutaneous and fasciocutaneous perforators together with venous and neural connections. The keystone flap minimizes the need for skin grafting in the majority of cases and produces excellent aesthetic results. Four types of flaps are described: Type I (direct closure), Type II (with or without grafting), Type III (employs a double island flap technique), and Type IV (involves rotation and advancement with or without grafting). The patient is almost pain free in the postoperative phase. Early mobilization is possible, allowing this technique to be used in short stay patients.Results:  In a series of 300 patients with flaps situated over the extremities, trunk and facial region, primary wound healing was achieved in 99.6% with one out of 300 developing partial necrosis of the flap.Conclusions:  The technique described in the present article offers a simple and effective method of wound closure in situations that would otherwise have required complex flap closure or skin grafting particularly for melanoma.
Acupuncture anaesthesia in inguinal hernia repair
Authors: Chu David Wa , Lee Daniel Tai‐Yam , Chan Tony Tung‐Fei , Chow Tam‐Lin , Que Manuel Bon‐We , Kwok Samuel Po‐Yin 
Published: December 2004

Background:  The present study was undertaken to evaluate the efficacy of acupuncture anaesthesia in inguinal hernia repair.Methods:  Twelve patients with non‐recurrent inguinal hernia had Lichtenstein mesh repair under acupuncture anaesthesia. Selected acupuncture loci were stimulated with fine needles connected to low frequency current. Supplementary local anaesthetic was given when required.Results:  Four (33%) patients reported satisfactory analgesic effect throughout the operation without need for additional medication, eight (67%) patients experienced mild discomfort during the operation requiring 1−4 mL of 1% lignocaine injection. Blood pressure and heart rate were stable during the procedure. All patients were able to sit up and resume their diet immediately post­operatively. All but one patient were discharged on day one after the procedure, with no early or late complications reported. Most patients were satisfied with the analgesic effect of acupuncture anaesthesia.Conclusions:  Acupuncture anaesthesia is a feasible anaesthetic option. It reduces the amount of local anaesthetic required, and thus the associated potential complications. It is effective in pain relief and inhibiting gastrointestinal upset. Postoperative recovery was rapid and complication free.
Measuring the importance of attributes that influence consumer attitudes to colorectal cancer screening
Authors: Salkeld Glenn P. , Solomon Michael J. , Short Leonie , Ward Jeanette 
Published: December 2004

Background:  The aim of the present study was to rate the importance of attributes of screening for bowel cancer.Method:  Randomly selected households in central Sydney were contacted to identify men and women aged 50−70 years who were then asked to complete a self‐administered questionnaire about bowel cancer screening and related issues. Seven hundred and ninety‐one residents (362 men and 429 women) returned questionnaires. Respondents were asked to rate the extent to which each of 34 attributes would encourage them to participate in bowel cancer screening.Results:  The three most highly rated attributes were: if the test was recommended by their general practitioner (GP; 94% either ‘strongly agreed’ or ‘agreed’); if the test identified early cancers (92%); and if the test would avert a premature death due to bowel cancer (90%). Having a friend or relative with bowel cancer (61%), advertising (41%) or famous people promoting the program (62%) were less influential. Respondents who were unemployed or on a pension were less likely to participate in screening than those who were employed if there was an ‘out of pocket’ charge of $15.00 (χ2 = 7.56, 2df, P = 0.006). Respondents with higher levels of education were significantly more concerned than respondents with lower levels of education about test accuracy (χ2 = 15.76, 2df, P < 0.001), its availability from their local chemist (χ2 = 16.96, 2df, P < 0.001), being able to return the test kit by post (χ2 = 21.9, 2df, P < 0.001) or deposit it with their local chemist (χ2 = 10.0, 2df, P < 0.01). They were also less likely to be influenced by a famous person promoting bowel cancer screening (χ2 = 18.87, 2df, P < 0.001).Conclusions:  Our results endorse the role of the GP in bowel cancer screening. However, the study also has demonstrated that test accuracy, the convenience of the screening service and notification of test results are valued differently by subgroups in the community, according to their level of education.
The effect of indole‐3‐carbinol and sulforaphane on a prostate cancer cell line*
Authors: Frydoonfar Hamid R. , McGrath Daniel R. , Spigelman Allan D. 
Published: December 2004

Background:  Cruciferous vegetable consumption is inversely related to the incidence of prostate cancer. We examined the effect of indole‐3‐carbinol (I3C) and of sulforaphane (constituents of cruciferous vegetables) on cell proliferation of a PC‐3 prostate cancer cell line, in order to observe if an inhibitory effect might be detected in vitro.Methods:  PC‐3 prostate cancer cells were cultured in 96‐well microtitre plates. Indole‐3‐carbinol concentrations ranging from 0.1 mmol/L to 0.8 mmol/L or sulforaphane concentrations ranging from 0.01 mmol/L to 0.06 mmol/L were added to the wells. Cell proliferation was measured by colorimetric assay and results were based on the mean value of triplicate experiments. Data are ­presented as medians and interquartile ranges and were analysed using the Mann−Whitney U‐test.Results:  Cell proliferation in PC‐3 prostate cancer cells was significantly inhibited by I3C and sulforaphane at media concentrations of 0.2 mmol/L and 0.02 mmol/L, respectively.Conclusion:  Both compounds inhibited the proliferation of prostate cancer cells in a dose‐dependant manner. These findings may help explain the observed protective effect of cruciferous vegetables in relation to prostate cancer.
Fluoropolymer coated Dacron or polytetrafluoroethylene for femoropopliteal bypass grafting: a multicentre trial
Authors: Robinson Brett I. , Fletcher John P. ,   the Australian and New Zealand Femoropopliteal Graft Trial Participants
Published: December 2004

Background:  This trial was designed to compare graft patency between expanded polytetrafluoroethylene (PTFE) and fluoro­polymer coated Dacron for femoropopliteal bypass in patients in whom saphenous vein was unavailable.Methods:  A multicentre prospective trial randomized 129 patients (74 men, 55 women) who underwent femoropopliteal bypass using either a PTFE or fluoropolymer coated Dacron graft. The indication for operation was disabling claudication in 68 (52.7%) and critical limb ischaemia in 61 (47.3%) patients. Distal anastomosis was above the knee in 76 (58.9%) and below the knee in 53 (41.1%) patients.Results:  Primary patency at 6, 12 and 24 months was 71%, 56% and 47% for PTFE and 50%, 36% and 36% for fluoropolymer coated Dacron (P = 0.002), respectively. Secondary patency at 6, 12 and 24 months was 77%, 60% and 48% for PTFE and 66%, 49% and 46% for fluoropolymer coated Dacron (P = 0.13), respectively. The superior primary patency of PTFE over fluoropolymer coated Dacron was most evident in patients with poor prognostic indicators for graft survival: critical limb ischaemia (P = 0.001); below‐knee anastomosis (P = 0.01); and smaller (6 mm) diameter grafts (P = 0.002). Graft thrombosis developed in the first month in 22 of 61 (36%) patients receiving fluoropolymer coated grafts compared to six of 68 (8.8%) patients receiving PTFE, which accounts for the difference in primary patency. Successful thrombectomy in 10 of the 22 fluoropolymer coated grafts resulted in similar secondary patency.Conclusion:  Polytetrafluoroethylene has superior primary patency and similar secondary patency to fluoropolymer coated Dacron. These results support the preferential use of PTFE in patients with critical limb ischaemia, especially when a below‐knee distal anastomosis and smaller diameter graft is required.
Endoluminal stent grafts for aortic diseases: experience at a major teaching hospital in Hong Kong
Authors: Ting Albert C. W. , Cheng Stephen W. K. , Ho Pei 
Published: December 2004

Background:  The purpose of the present paper was to review the initial experience of an endovascular aortic stent graft program at a major teaching hospital in Hong Kong.Methods:  Demographics, operative details, complications and follow‐up data of all the patients receiving endovascular repair for aortic disease were recorded prospectively.Results:  Between July 1999 and December 2001, endovascular repairs were attempted in 39 patients with aortic disease. The procedural success rate was 97.4%. Thirty‐three procedures were for abdominal aorto‐iliac aneurysms. Graft configuration was bifurcated in 28 patients (85%) while an aorto‐uni‐iliac device with a femoro‐femoral bypass was carried out in the remaining five patients. Thoracic procedures were carried out for one thoracic aortic aneurysm, two traumatic thoracic aortic injuries, one thoracic aortic dissection, and one thoracic aortic pseudoaneurysm with aorto‐oesophageal fistula. There was one hospital mortality (2.6%) from a type A thoracic aortic dissection with cardiac tamponade. Postoperative complications were seen in seven patients (18%). With a mean follow‐up of 11.6 ± 8.1 months, there was no open conversion or rupture. The endoleak rate was 27% at discharge, 15% at 6 months and 5% at 12 months postoperatively. For aneurysm endografts, the aneurysm sac decreased in size in 21 patients (62%), and remained static in 13 patients (38%).Conclusions:  The endoluminal stent graft appears to be a promising device that can be used safely in selected patients with aortic disease. Continued follow‐up is required to monitor the presence of endoleak and the size of the aneurysm sac.
Surgical trainees’ attitudes to specialization in breast surgery
Authors: Kollias James , Rainsbury Richard 
Published: December 2004

Background:  Subspecialization in general surgery is being encouraged by various surgical societies. The aim of this study was to view attitudes of Royal Australasian College of Surgeons (RACS) trainees to subspecialization in surgery, in particular, breast ­surgery.Methods:  A postal questionnaire survey of registered RACS basic and advanced surgical trainees was conducted in February 2002. Trainees were asked to nominate their preferred specialty and to indicate the level of support and interest for subspecialty training in breast surgery. Trainees indicating breast surgery as their preferred career choice were then asked to nominate their reasons for choosing breast surgery, preferred options for cross‐specialty training and for vocation specifications such as a continuing ‘on‐call’ responsibility.Results:  Trainees returned 291 of 1049 (28%) completed questionnaires. One hundred and sixty‐nine trainees felt that the concept of breast subspecialization in general surgery was reasonable (58%). For all respondents, the most popular specialty choices were plastic surgery (15.8%), orthopaedics (15.5%) and general surgery (15.4%). Breast surgery was chosen by 14 of 291 (4.8%) respondents as their first specialty preference and a further 25 respondents as their second specialty preference. Of 189 trainees who did not choose breast surgery as their preferred specialty, 45% stated repetitive stress, escalating litigation or demanding patients as deterrent factors. Only 36% of trainees interested in breast surgery were interested in undertaking after hours ‘on‐call’ work as a consultant, although 36 of 39 (92%) were interested in other forms of general or subspecialty elective surgical operating (i.e., endocrine surgery, surgical oncology) after completion of their training. According to trainees with an interest in breast surgery, the two most important aspects requiring inclusion in the proposed provisional training program were breast reconstruction (38%) and breast screen assessment (34%).Conclusion:  Breast surgery is an unpopular subspecialty for RACS trainees. Breast surgery is likely to experience increasing ­problems with recruitment unless the skill base is reviewed and revised in line with the aspirations and needs of today's trainees.
Endoscopic stapling for pharyngeal pouch: does it make the cut?
Authors: Aly Ahmad , Devitt Peter G. , Watson David I. , Jamieson Glyn G. , Bessell Justin R. , Chew Andrew , Krishnan Suren 
Published: December 2004

Background:  Endoscopic stapling to treat pharyngeal pouch is a relatively new technique with the potential to reduce the morbidity associated with the open approach for pharyngeal pouch. Despite enthusiasm for the endoscopic approach there have been no series reported in Australia, and descriptions of outcomes and benefits are currently anecdotal. The aim of the present study was to determine the outcome associated with endoscopic stapling of pharyngeal pouch in an Australian setting.Methods:  All patients admitted for endoscopic stapling for a pharyngeal pouch between 1998 and 2002 by surgeons from the Adelaide and Flinders Universities were identified, and their medical records were reviewed for clinical and operative details. All patients were interviewed by telephone using a structured questionnaire to determine symptom resolution and patient satisfaction. The Likert scale was used to assess the impact of preoperative and postoperative symptoms upon quality of life.Results:  A total of 31 patients were identified. The mean age of the group was 75 years (range: 35–91 years) and half the patients had an American Society of Anesthesiologists physical status score of 3 or greater. In four patients the procedure was abandoned; (for three because of inability to pass the diverticuloscope and for one because the pouch was too small). Standard open surgery was undertaken in these patients. Of the 27 procedures completed endoscopically, interview follow up was obtained in 23, at a mean follow up of 17 months (range: 2–68 months). Outcome was very good or excellent in 21 (91%), with significant symptom resolution, reduction in Likert scores and high patient satisfaction. Three patients had previously had pouch surgery and endoscopic stapling was straightforward in these patients. Recurrence of a symptomatic pouch occurred in three patients. There was no significant morbidity related to the procedure.Conclusions:  The early experience of endoscopic stapling for pharyngeal pouch in Adelaide is encouraging. The procedure achieves excellent control of symptoms and can be undertaken with minimal morbidity. Recurrence may be a problem, although repeat endoscopic stapling can be undertaken without difficulty.
Breast volume replacement using the latissimus dorsi miniflap
Authors: Nano Maria Teresa , Gill P. Grantley , Kollias James , Bochner Melissa A. 
Published: December 2004

Background:  Mastectomy is often recommended to women with early breast cancer who have large tumours or where the breast volume requiring resection to achieve adequate tumour clearance is too great to allow for a satisfactory cosmetic result after breast conservation surgery. The use of a latissimus dorsi muscular flap (latissimus dorsi miniflap (LDMF)) to replace the volume loss after major breast sector resection is an option where the tumour to breast volume ratio is large. The present study describes the technique and evaluates the experience of the LDMF at Royal Adelaide Hospital, Adelaide, Australia.Methods:  Between August 1997 and April 2002, 18 women aged 37–64 years underwent wide local excision for primary breast cancer with LDMF reconstruction. Tumour characteristics, breast specimen weight and postoperative sequelae were assessed. Quality of life measurements and objective assessments of aesthetic outcome were evaluated.Results:  Tumour diameter ranged from 13 to 80 mm (median 30 mm). Nine patients had multifocal or extensive intraductal component positive tumours. The weight of the resected specimens ranged from 75 to 395 g (median 130 g). There were no major postoperative complications, with a range of inpatient stay of 3–10 days. Seromas were aspirated in 14 patients but did not delay adjuvant treatment. Quality of Life results showed high patient satisfaction in all but one patient. A satisfactory cosmetic result was achieved in all but one patient who subsequently required mastectomy.Conclusion:  The LDMF procedure allows breast conservation to be achieved in women with large tumour to breast volume ratios, with satisfactory resection margins and good cosmetic and functional results. In the present experience standard oncological adjuvant treatment is not compromised.