bluuebunny/crossref_metadata_2025_split huggingface dataset:
INTERMITTENT SELF CATHETERIZATION VERSUS REGULAR OUTPATIENT DILATATION IN URETHRAL STRICTURE: A COMPARISON
Authors: Gnanaraj J. , Devasia A. , Gnanaraj L. , Pandey A. P. 
Published: March 2003

Background: The results of regular intermittent self catheterization were compared with regular outpatient dilatation after endoscopic internal urethrotomy for urethral strictures. Methods: The records of patients who were treated for urethral stricture disease over a 4‐year period from 1991 to 1994 were reviewed. They were either on regular urethral dilatation or were advised to carry out self calibration. A follow‐up questionnaire was sent to them and they were asked to attend a review. Student’s t‐test and Proportion Test were used to find out if there was any significant difference between the two groups. Results: There were 78 patients who were on self calibration and 49 patients on regular urethral dilatation. There was no significant difference between the two groups regarding the duration of follow‐up (21.5 and 23.7 months, respectively); the length of stricture (1.5 and 1.7 cm, respectively); and complications (two and four, respectively). However, patients on self calibration had narrower strictures (4.8 and 5.7 F) and a signficantly lower restricture rate (5 and 16%). The current urinary stream was compared to the immediate postoperative stream. This showed that a higher number of patients in the dilatation group were voiding at less than 25% of their immediate postoperative flow. People from high and low socio‐economic groups were able to carry out self calibration satisfactorily. Conclusion: Patients from high and low socio‐economic groups found that self calibration resulted in a lower restricture rate and better stream when compared to regular urethral dilatation.
QUALITY OF LIFE AFTER EMERGENCY ABDOMINAL AORTIC ANEURYSM REPAIR
Authors: Bohmer R. D. , Fleischl J. , Knight D. 
Published: March 2003

Background: Quality of life issues following surgical procedures, especially those with high mortality, should be of prime importance. There have been few studies on the quality of life of patients following emergency abdominal aortic aneurysm repairs. The decision to continue to offer surgery to these patients, especially with present monetary constraints, should rely heavily on quality of life issues. Audits of major surgical procedures should be undertaken and quality of life included. Methods: All patients in the Hawkes Bay area who had undergone emergency abdominal aortic aneurysm repairs since 1981 were identified and their quality of life assessed by means of the short form‐36 (SF‐36) questionnaire. Results: One hundred and fifteen patients were identified as having had an abdominal aortic aneurysm repaired as an emergency. Sixty patients died peri‐operatively and 19 subsequently. There were 28 patients available to complete the questionnaire, of whom 75% rated their global quality of life as good to excellent. Using the SF‐36 questionnaire, there was no statistically significant difference between those patients who had undergone surgery (whether proven leak or not) and the age‐matched healthy population. Conclusions: Quality of life remains good to excellent in the majority of patients following emergency abdominal aortic aneurysm repairs. This may help justify surgery being offered to patients with this condition. Quality of life should be considered as an important outcome rather than mortality only.
PRE‐OPERATIVE CHEMORADIOTHERAPY IN LOCALLY ADVANCED RECTAL CANCER
Authors: Elsaleh H. , Joseph D. , Levitt M. , House A. , Robbins P. 
Published: March 2003

Background: The aim of the present study was to investigate the effectiveness and toxicity of pre‐operative chemoradiation in locally advanced rectal cancer (T3–T4). Methods: Forty‐seven patients were assessed (38 T3 and nine T4 tumours). Pre‐operative pelvic radiotherapy was delivered in four fields, 45 Gy in 25 fractions over 5 weeks. Bolus 5‐fluorouracil (5‐FU) was delivered 500 mg/m2 on days 1, 2, 3 and days 22, 23, 24. Total mesorectal excision of the rectal tumour either by anterior or abdomino‐perineal resection was planned at 4–6 weeks from completion of pre‐operative treatment. Response to therapy was assessed by fresh macroscopic measurement of the surgical specimen. Results: All patients undergoing chemoradiation completed therapy as planned, with no treatment‐related interruptions. The regimen had a low acute toxicity profile with an estimated 50% or greater response in 38 out of 47 patients (four patients had complete responses). Forty‐three (97%) of 44 patients who underwent surgery were operable. Patients who were operated on between 4 and 7 weeks had a statistically better response then those who were operated on after 7 weeks (P = 0.013; Fisher’s exact test). Eight of 10 patients who were considered to be inoperable prior to the treatment underwent total mesorectal excision with negative radial margins. Anastomotic leakage occurred in four patients (9%); one required surgical intervention. Wound infection occurred in three patients (6%); one patient required re‐exploration for haemorrhage. Delayed complications occurred in three patients (6%); one requiring surgery for a stomal stricture. After a median follow‐up of 20 months, two patients (4%) had developed local recurrence. Conclusion: The pre‐operative chemoradiation regimen employed had a low acute toxicity profile and all patients completed therapy. The majority of patients considered inoperable prior to receiving this treatment underwent successful excision. Appropriately fractionated pre‐operative chemoradiotherapy is a reasonable option in this disease and deserves further evaluation.
LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA IN CIRRHOTIC PATIENTS
Authors: Chui A. K. K. , Rao A. R. N. , Mccaughan G. W. , Waugh R. , Verran D. J. , Koorey D. , Sheil A. G. R. 
Published: March 2003

Background: Hepatocellular carcinoma (HCC) in patients with cirrhosis, due to a limited liver reserve, is often deemed unresectable, even at an early stage. Methods: In order to evaluate the ongoing transplant programme for cirrhotic patients with HCC at Royal Prince Alfred Hospital, the results of liver transplantation (LTx) for HCC were analysed and the patient actuarial survival was compared with that of those LTx patients without malignancy. Results: A total of 441 LTx were performed in 404 patients between January 1986 and April 1998. Twenty‐four LTx recipients (22 men; two women) of mean age 49 (15–62) years had HCC. Twenty‐one had underlying aetiology for their cirrhosis (hepatitis B: n = 9; hepatitis C: n = 8; hepatitis B and C: n = 1; haemochromatosis: n = 1; autoimmune hepatitis: n = 1; alcoholism: n = 1), while three patients had cryptogenic cirrhosis. Six patients had incidental tumours and another two cases were of the fibrolamellar type. The average tumour size and tumour number were 2.9 (0.4–11.5) cm and 1.3 (1–4), respectively. Operative mortality was 4.2% (1/24). The HCC recurrence appeared in one (4.2%) patient (with a 11.5‐cm HCC) who died 18 months after LTx. A further two patients died (one graft failure from recurrent hepatitis C and one from fungal sepsis) during follow‐up. The overall 1‐ and 3‐year actuarial patient survival rates were 87% and 76%, respectively, and that of patients with benign causes (n = 369) were 77% and 72% (P = NS). Conclusion: With careful patient selection, long‐term tumour‐free patient survival can be achieved. The results support an active transplant programme for selected HCC.
SURGICAL REPAIR FOR RECURRENT ANTERIOR INSTABILITY OF THE SHOULDER
Authors: Yee ALBERT J. M. , Devane PETER A. , Horne GEOFFREY 
Published: March 2003

Background: The outcome of surgical repair for recurrent anterior instability of the shoulder at the Wellington Hospital was reviewed. Methods: A retrospective review was undertaken of patients undergoing surgical repair for recurrent anterior instability of the shoulder at Wellington Hospital between October 1989 and November 1996. Patients were asked to complete two shoulder‐specific questionnaires, and the range of motion, stability, and strength was evaluated clinically. Results: A total of 37 patients (38 shoulders) who had recurrent anterior dislocation of the shoulder that was unresponsive to a physician‐directed rehabilitation programme were managed with open surgical repair. Procedures included the Putti–Platt, Bristow, Magnuson–Stack, Botychev, and Bankart repairs. The mean age at the time of surgery was 24 years and the male‐to‐female ratio was 11.3:1. Surgery was performed on the dominant side in 63.2% of shoulders. The postoperative redislocation rate was 39.4% at an average of 4.6 years follow‐up. Three patients have since required revision of their surgical repair and one patient is awaiting revision. A total of 63.2% of patients were unable to return to their previous level of sports. Differences existed between the motion in the surgically treated shoulder when compared with the contralateral side. Patients reported the most functional difficulty in throwing, working overhead, pulling, and working at shoulder level. Conclusions: The results of the present study indicate a high redislocation rate, and highlight the challenges in restoring a stable, mobile, functional shoulder.
OPEN NISSEN FUNDOPLICATION AND HIGHLY SELECTIVE VAGOTOMY AS A TREATMENT FOR GASTRO‐OESOPHAGEAL REFLUX DISEASE
Authors: Bohmer R. D. , Roberts R. H. , Utley R. J. 
Published: March 2003

Background: Open Nissen fundoplication has been the most common surgical treatment of gastro‐oesophageal reflux disease (GORD). The present paper describes the symptomatic result, and quantifies the acid reduction achieved by open Nissen fundoplication combined with highly selective vagotomy (HSV) in a consecutive case series. Methods: A study of 106 patients undergoing open Nissen fundoplication and HSV for GORD was performed between 1988 and 1996. A history consistent with reflux was obtained and the diagnosis confirmed with ambulatory oesophageal pH studies and endoscopy. Postoperative pH studies were performed, and peri‐operative and late complications were recorded. A standard questionnaire was sent out to patients postoperatively to assess the efficacy of surgery. Results: Pre‐operative pH studies were performed on 104 (98%) patients, and on 97 (91.5%) following surgery. There was a highly significant improvement in all parameters of the pH study postoperatively. All symptoms, including bloating and dysphagia, improved significantly postoperatively, except flatulence, which was exacerbated. The majority of patients were very satisfied with their outcome, 82% rating the operation from 80 to 100% successful. Complications were rare and there was no mortality. Conclusions: Open Nissen fundoplication and HSV is an effective method of treating GORD, producing an improvement in symptoms and in ambulatory pH studies.
RISK FACTORS FOR SURGICAL WOUND INFECTION AND BACTERAEMIA FOLLOWING CORONARY ARTERY BYPASS SURGERY
Authors: Spelman Denis W. , Russo Philip , Harrington Glenys , Davis Bruce B. , Rabinov Marc , Smith Julian A. , Spicer W. John , Esmore Donald 
Published: March 2003

Background: There has been no consensus from previous studies of risk factors for surgical wound infections (SWI) and postoperative bacteraemia for patients undergoing coronary artery bypass graft (CABG) surgery. Methods: Data on 15 potential risk factors were prospectively collected on all patients undergoing CABG surgery during a 12‐month period. Results: Of 693 patients, 62 developed 65 SWI using the Centres for Disease Control definition: 23 were sternal wound infections and 42 were arm or leg wound infections at the site of conduit harvest. There were 19 episodes of postoperative bacteraemia. Multivariate analysis revealed that: (i) diabetes, obesity and previous cardiovascular procedure were independent predictors of SWI; and (ii) obesity was an independent risk factor for postoperative bacteraemia. Conclusions: These findings suggest that improved diabetic control and pre‐operative weight reduction may result in a decrease in the incidence of SWI. But further prospective studies need to be undertaken to examine (i) whether the increased SWI risk in diabetes occurs with both insulin‐ and non‐insulin‐requiring diabetes, and whether improved peri‐operative diabetes control decreases SWI; and (ii) what degree of obesity confers a risk of SWI and postoperative bacteraemia, and whether pre‐operative weight reduction, if a realistic strategy in this patient group, results in a decrease in SWI.
THYROID SURGERY AND VOICE‐RELATED OUTCOMES
Authors: Mcivor Nicholas P. , Flint David J. , Gillibrand Jeanette , Morton Randall P. 
Published: March 2003

Background: Vocal dysfunction in patients with thyroid pathology has been poorly documented, and dysfunction after thyroid surgery is generally reported in terms of recurrent laryngeal nerve or external laryngeal nerve palsy. But voice dysfunction is more complex than simply nerve integrity. The present study reports the incidence of dysphonia in patients presenting for thyroid surgery, and relates postoperative changes in vocal function to recurrent and external laryngeal nerve function, and the surgical handling of the strap muscles. Methods: Fifty patients were assessed by Visipitch before and after thyroidectomy. Following surgery the patients filled out a questionnaire. Results: Overall 26 of 44 patients had no subjective postoperative voice change, while 10 reported subjective deterioration and eight reported subjective improvement in voicing. Postoperative objective assessment of these patients found that 17 were the same, eight refused to come for testing because they felt their voice had not changed, 13 were better and six were worse. Following surgery two patients (4.5%) had temporary recurrent laryngeal nerve palsies (2.5% of nerves at risk), and four patients (10%) suffered external laryngeal nerve palsies. Division of strap muscles was not detrimental to voicing. Six patients were lost to follow‐up. Fifteen patients (34%) presented with vocal abnormalities, six (40%) of whom improved postoperatively. Conclusions: Patients may have voicing abnormalities before thyroid surgery is performed. Surgery may improve or worsen the voice irrespective of the pre‐operative voice status.
THE USE OF LAPAROSCOPY IN THE MANAGEMENT OF ADNEXAL PATHOLOGIES IN CHILDREN
Authors: Lee K. H. , Yeung C. K. , Tam Y. H. , Liu K. K. W. 
Published: March 2003

Background: The authors’ experience of using laparoscopy in the management of 23 girls (mean age: 8.9 years; range: 3 months–15 years) with various adnexal pathologies over a 3‐year period is reviewed. Methods: Of the 23 patients, seven were evaluated for congenital gonadal pathologies, 15 presented with abdominal pain and one patient had an antenatally diagnosed adnexal mass. Detailed laparoscopic examination of the pelvic cavity and laparoscopic gonadectomy were successfully performed in all seven patients with congenital gonadal pathologies: mosaic Turner’s syndrome (n = 2), gonadal dysgenesis (n = 3) and testicular feminization syndrome (n = 2). Of 15 patients presenting with abdominal pain, 11 had an adnexal mass, two had acute appendicitis and two had pelvic inflammatory disease. Results: Laparoscopic excision of the adnexal masses were successfully performed in 10 of 11 patients. Conversion to open surgery was required in one patient with a huge teratoma. Laparoscopic appendicectomy was successfully performed in both patients with acute appendicitis while diagnostic laparoscopy was the only procedure required in the two patients with pelvic inflammatory disease. Laparoscopy in the infant with an antenatally diagnosed adnexal mass confirmed this to be an omental cyst, which was successfully excised. All patients recovered without complications and good cosmetic result was universally achieved. Conclusion: Laparoscopy is safe and effective in both diagnosis and treatment of adnexal pathologies in children.
Thyroid pathology associated with primary hyperparathyroidism
Authors: Sidhu Stan , Campbell Peter 
Published: March 2003

Background: Thyroid carcinoma and benign thyroid disease associated with primary hyperparathyroidism (PHPT) have been well described. With the developing trend toward minimally invasive parathyroidectomy without intra‐operative thyroid gland palpation, thyroid pathology may be missed. The authors consider it timely to revisit the issue of thyroid pathology found at neck exploration for PHPT. Methods: A retrospective review of all cases of neck exploration for PHPT between 1993 and 1998 at Liverpool Hospital was undertaken. Results: There were 65 patients in the study group (44 women, 21 men; mean age: 59 years). The most common indication for surgery was asymptomatic hypercalcaemia. The mean pre‐operative calcium level was 2.9 mmol/L and the mean parathyroid hormone (PTH) level was 17 pmol/L. There were 26 cases (40%) of coexistent thyroid pathology. Ten cases (15%) were of mild multinodular change, seven cases (11%) were of severe multinodular change requiring thyroidectomy, three cases (4%) were nodules secondary to Hashimoto’s thyroiditis and six cases (10%) were suspicious nodules that proved to be either adenomas (n = 3) or carcinomas (n = 3) following excision. There were four papillary carcinomas detected in the present series with a mean metastases, age, completeness of excision, invasion size (MACIS) score of 4.92. Conclusion: A 25% association of significant thyroid pathology with PHPT is reported. Despite pre‐operative tests there were two cases (4%) of thyroid carcinoma where the decision to resect the thyroid gland was made following intra‐operative thyroid gland palpation. One of these two papillary carcinoma patients would have fulfilled criteria for minimally invasive parathyroid surgery. When evaluating results of minimally invasive parathyroid surgery one must be aware of the potential for missed thyroid pathology.
A SIMPLIFIED METHOD OF HARVESTING AND DILATING THE RADIAL ARTERY ACHIEVES ACCEPTABLE CLINICAL OUTCOMES
Authors: Esmore Donald S. , Burton Paul R. , Smith Julian A. , Rabinov Marc , Pick Adrian , Mcmahon John , Rosenfeldt Franklin L. 
Published: March 2003

Background: The recent successful revival of the radial artery as a coronary‐bypass conduit has been attributed to a minimally traumatic harvesting technique without diathermy, combined with long‐term oral calcium antagonist therapy. We describe a simplified technique of harvesting the radial artery, which reduces procurement time and maintains conduit relaxation. Methods: Radial arteries were harvested using diathermy and topical glyceryl trinitrate‐verapamil dilator solution. Postoperatively, intravenous glyceryl trinitrate, but no calcium antagonist was used. The clinical results in the first 100 consecutive patients receiving radial artery grafts (RA group), procured using this technique, were compared with a group of 100 patients receiving saphenous vein conduits (SV group) immediately prior to the introduction of the radial artery at our institution. Results: There were no demographic differences between the two groups, other than the SV group being slightly older. There was one intraoperative death in each group. There was no difference in the rate of peri‐operative myocardial infarction or length of stay in the intensive care unit. At a median follow‐up time of 16 months for the RA group, and 25 months for the SV group, the survival rates were 97 and 94%, respectively. All survivors were in the New York Heart Association class I. In the SV group, two postoperative angioplasties were performed. Conclusions: These early results suggest that this method of procuring the radial artery using diathermy, glyceryl trinitrate and no postoperative calcium antagonists, is rapid, safe and effective. The continued use of this technique is justified, while awaiting the results of long‐term angiographic studies.
LAPAROSCOPIC TENCKHOFF CATHETER INSERTION: A PROSPECTIVE STUDY OF A NEW TECHNIQUE
Authors: Poole G. H. , Tervit P. 
Published: March 2003

Background: This study describes a new technique of laparoscopic Tenckhoff catheter insertion. Methods: During a 12‐month period, 53 consecutive patients requiring insertion of peritoneal dialysis catheters were studied prospectively. A new technique of laparoscopic insertion was developed. Results: Forty‐eight patients out of 49 (98%) had successful insertion. Four patients were excluded with active peritonitis. There was an early complication rate of 8% (4/49) and a late complication rate of 14% (7/49). There was 12% overall failure of catheter with a mean follow up of 6 (1–13) months. Conclusion: This new laparoscopic technique maximizes the advantages of laparoscopic surgery and has complication rates which compare favourably with other open and laparoscopic techniques.
Restoration of Shoulder Abduction in Brachial Plexus Injury with Phrenic Nerve Transfer
Authors: Sungpet Adisak , Suphachatwong Chanyuth , Kawinwonggowith Viroj 
Published: March 2003

Background: Shoulder abduction is one of the most essential functions in reconstruction of the brachial plexus following injury. In the literature there are few reports on phrenic nerve transfer, especially in relation to restoration of shoulder function. The purpose of the present study was to evaluate the clinical effectiveness and safety of phrenic nerve transfer. Methods: A study was made of 10 cases of phrenic nerve transfer to the suprascapular nerve. Results: The average shoulder abduction was 41° (range: 20–60°). The average degree of shoulder abduction in patients with C5 or C6 root avulsions was slightly more than that in the patients with total root avulsions. There was no clinically significant respiratory insufficiency in any patient. Conclusions: Phrenic nerve transfer to the suprascapular nerve is an effective, reliable and safe method of shoulder abduction restoration in brachial plexus injury.
Blunt Traumatic Small Bowel Rupture: Are Children Different?
Authors: Hamill James , Paice Rhondda , Civil Ian , Kolbe Anne 
Published: March 2003

Background: In order to identify differences between children and adults with small bowel rupture (SBR) and to determine if a single diagnostic approach could be taught to paediatric and adult surgeons, a review of the experience at a children’s and an adults’ hospital was performed. Methods: Using the hospital patient database 17 children were identified with SBR over a 13.6‐year period, and clinical records were available for review for 14. Using a trauma registry 16 adults were identified with SBR over a 4.7‐year period and clinical records were reviewed in all 16. Results: The population incidence was 0.48/100 000 per annum in children and 0.58/100 000 per annum in adults. Motor vehicle crash was a less common mechanism of injury in children (35.7%) than in adults (75%). The time from injury to presentation (presentation interval) was significantly longer in children than in adults, even after excluding child abuse cases (median 2.9 h vs 65 min, respectively). The injury severity score was lower in children (median: 10) than in adults (median: 16.5). Peritoneal signs on follow‐up examination were documented in 54.6% of children and in 90.9% of adults in whom follow‐up examination was performed. Clinical findings on admission, findings on computed tomography, indications for operation and outcome were similar in children and adults. Conclusion: Children differed from adults in aetiology, longer presentation interval and fewer associated injuries. Similarities in diagnostic parameters suggest that a single diagnostic approach could be taught for children and adults provided that the limitations of physical examination in small children are recognized.