bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcome following total laryngectomy for cancer
Authors: Hall Francis T. , O'Brien Christopher J. , Clifford Anthony R. , McNeil Edward B. , Bron Luc , Jackson Michael A. 
Published: May 2003

Background:  Patients with advanced cancers of the larynx and hypopharynx have been treated with total laryngectomy at the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney in the past. Increasingly, these patients are being managed with organ‐sparing protocols using chemo­therapy and radiotherapy. The aim of the present study was to review complication, recurrence and survival rates following total laryngectomy.Methods:  Patients who had total laryngectomy for squamous carcinomas of the larynx or hypopharynx between 1987 and 1998 and whose clinicopathological data had been prospectively accessioned onto the computerized database of the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, were reviewed. Patients whose laryngectomy was a salvage procedure for failed previous treatment were included.Results:  A total of 147 patients met the inclusion criteria for the study, including 128 men and 19 women with a median age of 63 years. Primary cancers involved the larynx in 90 patients and hypopharynx in 57. There were 30 patients who had recurrent (n = 24) or persistent disease (n = 6) after previous treatment with radiotherapy (26 larynx cases and four hypopharynx cases). Pharyngo‐cutaneous fistulas occurred in 26 cases (17.7%) and, using multivariate analysis, the incidence did not correlate with T stage, previous treatment or concomitant neck dissection. Local control rates were 86% for the larynx and 77% for the hypo­pharynx groups and neck control was 84% and 75%, respectively. Five‐year survival for the larynx cancer group was 67% and this was significantly influenced by T stage and clinical and pathological N stage. Survival in the hypopharynx group was 37% at 5 years and this did not significantly correlate with T or N stage. There was a non‐significant trend to improved survival among previously treated patients whose laryngectomy was a salvage procedure.Conclusion:  Patients with cancer of the larynx had a significantly better survival following total laryngectomy than patients with hypopharyngeal cancer. Those whose laryngectomy was carried out as a salvage procedure following failed previous treatment did not have a worse outcome than previously untreated patients.
Laser tenotomy and vocal process resection for bilateral midline vocal fold fixation
Authors: Havas Thomas E. , Priestley K. Jocelyn 
Published: May 2003

Background:  The present retrospective study presents the outcomes of a group of 21 patients with laryngeal obstruction caused by bilateral vocal fold fixation. All of these patients were treated by laser assisted muscle tenotomy and vocal process resection − a modification of the technique described by Michael and Eugene Rontal in 1994.1Methods:  Between January 1997 and March 2002 the senior author performed muscle tenotomy and vocal process resection for bilateral vocal fold fixation on 21 patients.Results:  The mean follow‐up time was 2.3 years. The technique was successful in achieving an adequate airway and good voice with no aspiration in every case.Conclusions:  Laser assisted muscle tenotomy and vocal process resection is a proven treatment for bilateral medial vocal fold fixation with the provision of a good airway, good voice and the avoidance of aspiration.
Intermediate to long‐term results of repairing incompetent multiple deep venous valves using external valvular stenting
Authors: Lane Rodney James , Cuzzilla Michael Luciano , McMahon Christopher Gordon 
Published: May 2003

Introduction:  Chronic venous insufficiency is a major cause of morbidity in the community. The purpose of the present study was to assess the efficacy and safety of repairing multiple deep venous valves with an External Valvular Stent.Methods:  Forty‐two limbs with chronic venous disease were operated on between 1987 and 1991. The patients included in the present series have now had more than 5 years of follow up (mean: 7.9 years; range: 5.4−11.9 years). Most patients had primary deep venous incompetence. There were 125 valve repairs out of 146 venographically suitable valves primarily in the superficial femoral and popliteal veins (2.98 per limb). Follow up was incomplete because of the duration of the trial.Results:  Following surgery ulcer areas decreased from a mean preoperative value of 12.9 cm2 to 1.2 cm2 at 86 months with almost 80% of the ulcers healed. All symptoms, pain, swelling, cramps and pigmentation were improved at a statistically significant level. The 90% infrared photoplethysmography recovery time almost doubled from 6.7 s preoperatively to 12.4 s at 36 months and were unchanged in the long term. Venous pressures were only significant at 12 months post implantation. Using multivariant analysis, the number of stents implanted was statistically associated with an increased number of ulcers healing. The site of venous valve repairs seems to be irrelevant to all of the variables.Conclusion:  Multiple deep venous valve repairs are appropriate and the best form of treatment for specifically selected individuals with primary deep venous incompetence.
Acute generalized peritonitis in African children: assessment of severity of illness using modified APACHE II score
Authors: Adesunkanmi A. R. K. , Oseni S. A. , Adejuyigbe O. , Agbakwuru E. A. 
Published: May 2003

Background:  Generalized surgical acute abdomen is a significant cause of morbidity and mortality among children. Severity assessment is useful in order to prioritize treatment and reduce complications. Patients with a high severity score are often faced with high morbidity and mortality, thus, requiring more intensive treatment than those with low severity scores. The purpose of the present study was to assess the severity of the acute abdomen in paediatric patients using a modification of the acute physiological and chronic ill‐health evaluation II score (APACHE II).Methods:  Children admitted and operated on for generalized acute abdomen over a period of 7 years from January 1993 to December 1999 were prospectively studied. A study proforma was drafted and demographic, clinical, preoperative, operative and postoperative data on each patient were entered. Each patient had severity of illness assessed using APACHE II parameters with minor modification to make it applicable to children. Postoperative outcome and severity of illness were compared to determine any correlation.Results:  There were 69 patients operated on within the period of the study. Age ranged from 3 months to 15 years, with a mean of 9.1 SD 4.3 years. Forty‐two patients (61.2%) were male and 27 (39.8%) were female. Typhoid intestinal perforation accounted for 35 (50.7%) and intestinal obstruction with or without intestinal gangrene accounted for nine (13%). Modified APACHE II score ranged from 0 to 18, mean 8.5 SD 5. For survivors, the mean score was 8; for non‐survivors, 13. Eight patients died (11.6%): four of 63 (6.4%) patients who scored 0−15 died; four of six (66.7%) patients who scored 16−18 (P < 00.05) died. A modified APACHE II score greater than 15 was associated with a significantly greater mortality. The data for postoperative morbidity and hospital stay were not conclusive.Conclusion:  Although the APACHE II score was designed for adults, a modification can be suitably applied to predict mortality in children with generalized peritonitis. There will be a need to apply this to large number of patients in order to validate our finding.
Intraoperative lymph node staging of prostate cancer: the case against
Authors: Garrett Kerry L. , McNeal John E. , Cohen Ronald J. 
Published: May 2003

Background:  Intraoperative frozen section analysis of obturator nodes is an accepted screening procedure, excluding from prostatectomy that group of node‐positive patients who are presumed to almost always have disseminated cancer. The overall efficacy of this procedure depends not only on the near inevitability of cancer progression in these patients, but also the procedure morbidity (previously estimated at 8.4%), the additional costs (currently estimated at A$1200) and the infrequency of positive nodes. We evaluate the efficacy of lymph node staging for prostate cancer.Methods:  We have evaluated the efficacy of intraoperative screening by node dissection in 123 prostatectomy cases. These cases were prescreened from a series of 261 radical prostatectomies by evaluating preoperative serum PSA and Gleason grade.Results:  Three patients were identified with nodal disease, representing a detection rate of 2.4%. The present study confirms that current trends in prostate cancer identification and selection of individuals for radical surgery very rarely identify node‐positive disease even after preselection with accepted ‘high‐risk’ markers.Conclusion:  Considering the attendant cost and morbidity, there appears to be no justification for lymph node dissection as a routine preliminary to prostatectomy.
In vitro comparison of glyceryl trinitrate‐verapamil with other dilators of human saphenous vein
Authors: Jesuthasan L. S. Bruno , Angus James A. , Rosenfeldt Franklin L. 
Published: May 2003

Background:  A common problem encountered during harvesting of the saphenous vein for coronary artery bypass grafting (CABG) is spasm of the vein. The previous work of the present authors has led to the development of a dilator solution containing glyceryl trinitrate (GTN) and verapamil for use during harvesting of the saphenous vein (SV) and the internal mammary artery. The present organ bath study was designed (i) to determine the best vasodilator agents for the saphenous vein during harvesting and (ii) to investigate the presence of any synergistic effect when vasodilator agents are combined.Methods:  Discarded segments of saphenous vein were collected from 46 patients undergoing CABG and studied in organ baths. Initially veins were contracted with potassium or thromboxane A2 mimetic (U46619). Dilators were added individually or in com­bination in clinically relevant concentrations to study time of onset and maximum effect. The vasodilator agents tested included GTN, verapamil (V), sodium nitroprusside (SNP) and nicorandil (N).Results:  When rapidity of onset (i.e. relaxation caused in the first minute) was considered, GTN or combinations containing GTN, caused a response that was significantly faster than the other vasodilators (P < 0.05). The maximum response caused by the GTN−V combination (61.4 ± 9.6%) was significantly greater than all the other single dilators, SNP (35 ± 4%) and N (10 ± 3%) (P < 0.05). However, no synergistic effects were demonstrated.Conclusions:  The present paper demonstrates the following conclusions: (i) glyceryl trinitrate is a rapidly acting dilator of the human isolated SV. (ii) GTN−V combination is a potent combination causing a maximum dilator effect that is significantly greater than single agents including SNP and N.
Day‐only laparoscopic cholecystectomy in a regional teaching hospital
Authors: Blatt Alison , Chen Stanley 
Published: May 2003

Background:  Day‐only laparoscopic cholecystectomy (DOLC) has been demonstrated to be a safe and feasible procedure. The aim of the present study was to introduce DOLC to a busy teaching hospital without a separate day‐surgery facility, to identify any problems associated with early discharge, and to determine patient satisfaction.Methods:  Over a 2‐year period, all patients undergoing elective laparoscopic cholecystectomy under one surgeon were prospectively studied. Patients satisfying criteria for DOLC were offered the procedure. All patients were sent anonymous satisfaction surveys postoperatively.Results:  One hundred and one patients underwent elective laparoscopic cholecystectomies and 41 of these patients were booked for DOLC. Thirty‐three (80%) were successfully discharged the same day and there were no complications related to early discharge. Only two of eight unplanned admissions were because of postoperative pain or nausea. Thirty‐two (78%) of DOLC patients replied to our survey and of those, 24 (78%) were satisfied with their length of stay. The extra strain placed on day‐stay ward resources was reflected in patient survey comments on their care.Conclusions:  Our findings support the evidence that DOLC is safe and feasible. However, in a busy teaching hospital with tight budget constraints and no separate day‐surgery facility we found many patients satisfied with their length of stay but not always with the quality of care they received on the day‐stay ward. The latter was insufficiently equipped to handle procedures of this complexity. So although in theory DOLC has many advantages, we are unable to institute this as routine practice at this time.
Spinal and spinal cord injuries in horse riding: the New South Wales experience 1976−1996
Authors: Roe Justin P. , Taylor Thomas K. F. , Edmunds Ian A. , Cumming Robert G. , Ruff Stephen J. , Plunkett‐Cole Meg D. , Mikk Marje , Jones Richard F. 
Published: May 2003

Objectives:  The objective of the present study was to determine the incidence of acute spinal cord injuries (ASCI) in all forms of horse riding in New South Wales (NSW) for the period 1976−1996. Other aims of the present study were to compare and contrast ASCI with vertebral column injuries (VCI) without neurological damage and to define appropriate safety measures in relation to spinal injury in horse‐riding.Design:  A retrospective review was done of all ASCI cases (n = 32) admitted to the two acute spinal cord injury units in NSW for the cited period. A comparable review of VCI cases (n = 30) admitted to these centres for the period 1987−1995 was also undertaken.Results:  A fall in flight was the commonest mode of injury in both groups. Occupational and leisure riding accounted for 88% of ASCI and VCI. The incidence of ASCI is very low in those riding under the aegis of the Equestrian Federation of Australia − two cases in 21 years; and there were no cases in the Pony Club Riders or in Riding for the Disabled. The difference in the spinal damage caused by ASCI and VCI is in degree rather than kind. Associated appendicular/visceral injuries were common.Conclusions:  No measures were defined to improve spinal safety in any form of horse riding. The possible role of body protectors warrants formal evaluation. Continued safety education for all horse riders is strongly recommended.
Current attitudes to total hip replacement in younger patients: a comparison of two nations
Authors: Hardidge Andrew J. , Hooper Jonathan , McMahon Stephen 
Published: May 2003

Introduction:  Orthopaedic surgeons performing total hip replacements (THR) today are faced with a vast array of options. Inspired by a recent UK study, we wanted to determine the current trend in prosthesis choice, fixation and bearing surfaces used in ‘young’ Australian patients, and to compare this trend to the UK.Methods:  A questionnaire identical to that used in the UK study was posted to all current members of the Australian Orthopaedic Association and returned questionnaires were directly compared to the UK results on a percentage‐of‐responses basis.Results:  Two hundred and forty‐six valid responses were received. The number of THR reported to be performed by these respondents (15 789) was equivalent to the estimated number of prostheses sold here during the same period (15 624). The UK results showed a predominant use of Charnley and Exeter femoral prostheses, an all‐polyethylene acetabular component, and cement fixation of both the acetabular and femoral components for both their older and younger patients. In younger patients, Australian surgeons favoured uncemented fixation techniques for the femur (57%vs 23%), and especially the acetabulum (85%vs 32%). There was a higher percentage use of modular design (95%vs 67%) and a very high use of ceramic as a bearing surface, 49% (vs 25%) using it for the femoral head, and 21% (vs 2%) employing a ceramic‐on‐ceramic bearing combination.Discussion:  Despite being privy to the same published papers, the THR prosthesis and fixation preferences of UK and Australian orthopaedic surgeons are markedly different. This may be because of interpretation of papers, peers, personal experience, patient assessment, budgets, institutions, theories, fashions, differences in autonomy and advertising.
Embryonic parathyroid rests occur commonly and have implications in the management of secondary hyperparathyroidism
Authors: Aly Ahmad , Douglas Malcolm 
Published: May 2003

Background:  Recurrence after surgery for secondary hyperparathyroidism is not infrequent. Regrowth of the residual parathyroid tissue after subtotal parathyroidectomy or of the autograft after total parathyroidectomy occurs in many cases. Supernumerary glands are also frequently cited as the offending cause and upon revisiting the neck, the surgeon may be surprised that such an obvious gland was ‘missed’ at the first operation. Indeed, multiple glands removed in sequential operations have been reported suggesting that they develop over time rather than being present from the start. It is possible that microscopic parathyroid ‘rests’ of embryological origin proliferate under the ongoing stimulus of renal failure to produce supernumerary glands after apparently adequate initial surgery for hyperparathyroidism. The aim of the present study was to determine whether such rests occur frequently or infrequently.Methods:  Operative details and pathology results from 60 consecutive parathyroidectomies were reviewed and the occurrence of parathyroid rests noted.Results:  Parathyroid rests were found in 37% of extra parathyroidal tissues submitted for analysis. These rests were found commonly in the thymus. The potential significance of such parathyroid rests undergoing hyperplasia in response to the ongoing stimulus of renal failure and leading to recurrent hyperparathyroidism is discussed.Conclusion:  Parathyroid rests are common and potentially serve as a cause of recurrent disease in secondary hyperparathyroidism. Consideration should be given to performing thymectomy as part of the treatment of secondary hyperparathyroidism. A more detailed study is warranted.
Men with colorectal cancer are predisposed to prostate cancer
Authors: Moot Andrew R. , Polglase Adrian , Giles Graham G. , Garson O. Margaret , Thursfield Vicky , Gunter David 
Published: May 2003

Background:  The objective of the present study was to investigate the relationship between colorectal and prostate cancer.Methods:  All Victorian men who developed metachronous colorectal and prostate cancer with the first primary diagnosed between 1982 and 1993 were identified retrospectively from the Victorian Cancer Registry and were followed up to the end of 1995. Analyses were stratified by age group and years of follow up. The cause of death in those men who had prostate cancer following colorectal cancer was determined. The stage of colorectal cancer was compared between men with and without second primary prostate cancer and the grade of prostate cancer was compared with men who did not have a prior colorectal cancer.Results:  Men who develop colorectal cancer are at increased risk of prostate cancer, with the greatest risk in men under the age of 65 (Relative risk ∼2). Men with first primary colorectal cancer are more likely to develop prostate cancer than colorectal second primaries, and men who develop second primary prostate cancer are more likely to die of prostate cancer than colorectal cancer.Conclusions:  Younger men diagnosed with colorectal cancer are at increased risk of prostate cancer. However, there is no direct evidence that screening for prostate cancer leads to a reduction in mortality. This should be considered when discussing long‐term follow up.
Radical lymph node dissection for melanoma
Authors: Serpell Jonathan W. , Carne Peter W. G. , Bailey Michael 
Published: May 2003

Background:  Therapeutic lymph node dissection for melanoma aims to achieve regional disease control. Radical lymphadenectomy (RLND) can be a difficult procedure associated with significant postoperative morbidity.The aims of the present study were to review regional disease control and morbidity in a series of lymphadenectomies performed within a specialist unit.Methods:  The present study involved the analysis of 73 lymphadenectomies in 64 patients, from 1995 to 2001.Results:  The overall wound complication rate after inguinal lymphadenectomy (71%) was higher than after axillary lymphadenectomy (47%; P = 0.05). After inguinal lymphadenectomy, the wound infection rate was higher (25.0%vs 5.9%; P = 0.03), delayed wound healing was more frequent (25.0%vs 5.9%; P = 0.03), and the mean time that drain tubes remained in situ was longer (12.5 vs 8.2 days; P = 0.05). There were no significant differences in seroma (46%vs 32%) rates. Lymphoedema was more common after inguinal lymphadenectomy (P < 0.02). Multivariate analysis identified inguinal RLND (P = 0.002) and increasing tumour size (P = 0.045) as predictors of wound morbidity. More patients received postoperative radiotherapy after neck RLND compared to inguinal or axilla RLND (P = 0.03). Six (8%) patients developed local recurrence after lymphadenectomy. At a median follow up of 22 months, 34 (53%) patients have died, from disseminated disease.Conclusions:  Radical lymphadenectomy for melanoma is associated with significant morbidity. Inguinal node dissection has a higher rate of complications than axillary dissection. Low local recurrence rates can be achieved, limiting the potential morbidity of uncontrolled regional metastatic disease.
Biliary access loops for intrahepatic stones: results of jejunoduodenal anastomosis
Authors: Ramesh Hariharan , Prakash Kurumboor , Kuruvilla Kuruvilla , Philip Mathew , Jacob George , Venugopal B. , Lekha V. , Varma Deepak 
Published: May 2003

Background:  Patients with intrahepatic calculi require multiple interventions following successful surgical stone clearance for recurrent stones and cholangitis. The present paper describes the results of a technique of in‐continuity side‐to‐side jejunoduodenal anastomosis (JDA) that provides endoscopic access to the hepaticojejunostomy and intrahepatic ducts. This operation is compared to other techniques in a critical appraisal of various biliary access procedures described for long‐term management of intrahepatic ­calculi.Methods:  A retrospective analysis of clinical data of 13 patients who underwent biliary drainage procedures with access loops for intrahepatic calculi during the period March 1990 to December 2000 was performed. The postoperative course of patients and the feasibility of postoperative endoscopic access to the hepaticojejunostomy and intrahepatic ductal system in treatment of recurrent cholangitis were assessed. Nine patients underwent JDA, two underwent permanent‐access hepaticojejunostomy (PAH) and two others underwent an interposition hepaticojejunoduodenostomy (IHJ).Results:  The analysis revealed no major procedure‐related complications or mortality. Endoscopic access (using forward‐viewing gastroscope) was possible in 100% of cases following JDA, and with difficulty in both cases after PAH. Endoscopic access in the two patients with IHJ failed because of technical reasons. Recurrent cholangitis was seen in seven patients (54%) − two out of two patients in the PAH group, one out of two in the IHJ group and four out of nine in the JDA group. This required 12 endotherapy sessions (mean: 1.5 procedures per patient).Conclusion:  In‐continuity side‐to‐side JDA allows easy access of conventional gastroduodenoscopes to the biliary tree for removal of recurrent/residual intrahepatic stones. The technique has advantages over other access loop procedures in the long term management of recurrent intrahepatic stones.