bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE JOHN GRAHAM EXTRICATION PRIZE: ITS HISTORY AND IMPORTANCE
Authors: Miller BRIAN J. 
Published: March 2003

Background: The Early Management of Severe Trauma (EMST) course is unique in providing instructive exposure to techniques used in the extrication of severely injured victims from difficult locations using a role play method. Dr John C. Graham FRACS, vascular surgeon in Lismore, was responsible for the initiation of this concept in 1989. Since this component of the trauma course is not used in the Advanced Trauma Life Support (ATLS)® course in the USA, from which the EMST course was derived, the purpose of the present study is to determine the opinions of all EMST course directors as to the value of including an extrication scenario station in the EMST course in its current form in Australia and New Zealand. Methods: The extrication station as devised by John Graham consists of four 40 min scenarios offered to all 16 participants of an EMST course in groups of four. The participants are required to extricate a moulaged victim from a difficult location within the time available in the most skilful and expeditious manner. A prize is offered for the group performing the task best. A survey of the 45 EMST course directors was undertaken by questionnaire. Replies were anonymous. Results: There was a good response rate of 87%. Ninety‐two per cent of responding directors routinely used an extrication station. Two directors used the station occasionally and only one director never used it. The most frequently cited reason for use was that the participants come to appreciate commonly encountered problems in extrication, and how EMST principles are applied in the field. Second, the station allows the use of teamwork. Third, it adds entertainment to the course overall. There was a prize awarded by every course director for the winning group of participants. Ninety per cent of these prizes were named the ‘John Graham Extrication Prize’. Conclusions: The extrication station is considered constructive by the great majority of EMST directors. Both historical and competitive aspects are important since most directors still award a named prize for this station. The extrication station promotes a feeling of cohesion among Faculty and participants on an EMST course. The station is a memorable event for many participants and should be retained as a uniquely Australasian contribution to the course.
NITRIC OXIDE BIOSYNTHESIS AND MALONDIALDEHYDE LEVELS IN ADVANCED BREAST CANCER
Authors: Alagöl H. , Erdem E. , Sancak B. , Turkmen G. , Camlibel M. , Bugdayci G. 
Published: March 2003

Background: Nitric oxide (NO) is a free oxygen radical studied in many tissues. Its tumour killing structure is shown especially by macrophages. The end products of NO are nitrite and nitrate. Their plasma levels are used biochemically to determine nitric oxide synthase (NOS) activity. The proliferative capacity of cancer cells accompanies the alteration in oxidant–anti‐oxidant status. The risk of breast cancer is decreased in association with an increased level of polyunsaturated fatty acids in the erythrocyte membranes. The more the anti‐oxidant capacity increases, the more the transformed cells grow. Malondialdehyde (MDA) is a lipid peroxidation marker, and low plasma levels of MDA are associated with advanced stages of breast cancer. Methods: In the present study, the alteration of serum plasma levels of nitrate, nitrite and MDA were determined in patients with stage IIIB breast cancer and controls. Results: It was found that products of NO biosynthesis were higher and plasma MDA levels were lower in patients with breast cancer. Conclusions: It can be stated that in advanced breast cancer, the NO radical production is increased while the lipid metabolism is altered, and these changes can be related to an alteration in oxidant–anti‐oxidant status.
THE COST OF ELECTIVE AND EMERGENCY REPAIR OF AAA IN PATIENTS UNDER AND OVER THE AGE OF 80
Authors: Bagia J. S. , Robinson D. , Kennedy M. , Englund R. , Hanel K. 
Published: March 2003

Background: As Australia’s population ages, the number of elderly patients presenting for surgery of abdominal aortic aneurysms (AAA), both elective and ruptured, will increase. The aim of the present study was to compare the costs of treatment of patients with AAA, under and over the age of 80, in the elective and emergency settings in a hospital with a divisional structure in which the true costs can be accurately obtained. Methods: A total of 40 patients were selected at random from a series of 267 patients treated with open surgery for AAA between January 1987 and December 1994, 10 in each of four groups: group A, elective repair in patients aged < 80 (171/267); group B, elective AAA repair in patients aged > 80 (25/267); group C, emergency AAA repair in patients aged < 80 (50/267); and group D, emergency AAA repair in patients aged > 80 (11/267). A retrospective analysis of the hospital costs of treatment of these patients at St George Hospital was conducted. These true costs were then compared to Australian National Diagnostic Related Group (AN‐DRG) costs. Results: Group A and B had no mortality. In Group C and D the mortality was 20 and 60%, respectively. The emergency treatment groups also had longer lengths of stay. A statistically significant difference in cost of AAA repair between elective and emergency groups in both age groups was seen; that is, group A cost less than group C and group B cost less than group D. Costs per survivor, however, showed a dramatic difference between the cost of group C patients ($30 000) and group D patients ($60 000). In comparison with AN‐DRG calculated costs, the true costs of groups A and B were equivalent to AN‐DRG costs. In the emergency groups, how‐ ever, there were marked discrepancies between the true cost ($61 000) and that calculated by the DRG ($25 000) in group D, with similar differences seen in group C to a lesser extent. Conclusion: Emergency repair of AAA is significantly more expensive and has a high mortality in the over‐80 age group. Also, there is a substantial shortfall between the true costs of treating these patients and the funds allocated for treatment in this group.
DONOR SITE MORBIDITY IN THE ILIAC CREST BONE GRAFT
Authors: Hill Nicola M. , Geoffrey Horne J. , Devane Peter A. 
Published: March 2003

Background: Open iliac crest bone grafting is a common surgical procedure with recognized short‐term complications. The present paper documents the medium‐ to long‐term complications and level of patient satisfaction following the procedure. Methods: Seventy‐three patients undergoing an open iliac crest bone graft over the past 6 years at Wellington Hospital were retrospectively reviewed. All patients completed a postal questionnaire which assessed their current pain, sensory changes in and below the scar, scar appearance and overall appearance with the bone graft donor site. Results: Sixteen patients (21.9%) reported pain, 11 patients (15%) stated that their scar was sensitive to touch and 19 patients (22%) reported a degree of sensory change below the scar. Six patients (8.2%) felt that the scar appearance was totally unacceptable. Overall satisfaction, however, was high with 70 patients (95.8%) ‘fairly satisfied’ or ‘totally satisfied’ with their iliac crest donor site. Conclusions: Bone grafting from the iliac crest is a relatively benign procedure in terms of patient satisfaction, and the most significant morbidity is pain.
THE BLOOD SUPPLY OF THE BILIARY DUCTAL SYSTEM AND ITS RELEVANCE TO VASCULOBILIARY INJURIES FOLLOWING CHOLECYSTECTOMY
Authors: Vellar IVO D. 
Published: March 2003

Background: Cholecystectomy remains the only satisfactory treatment for symptomatic gall bladder stones. Unfortunately, in some cases the operation is complicated by vasculobiliary injury. The present study was undertaken to investigate the blood supply of the normal biliary system, to simulate vasculobiliary injuries described after cholecystectomy, and to determine the possible effects of the vascular injury on biliary reconstruction. Methods: The blood supply of the biliary system in nine normal livers was investigated by injection of the coeliac axis and superior mesenteric arteries with coloured gelatin. The specimens were dissected under magnification and drawings prepared. Injection dissection studies were also carried out in eight specimens in which various vasculobiliary injuries encountered after cholecystectomy were simulated. Results: The bile ducts possess an arterial plexus on their surface which is supplied from below by ascending marginal vessels derived from the postero‐superior pancreaticoduodenal artery. These marginal vessels end above in the right hepatic artery or its branches. The right and left hepatic ductal systems are supplied by the right and left hepatic arteries and their sectoral or segmental branches. The right and left hepatic arteries communicate freely via the hilar plate arterial plexus. This collateral system allows the blood supply to the right hepatic duct to be maintained after ligation of the right hepatic artery and interruption of the common hepatic duct or excision of the confluence. Conclusion: A knowledge of the blood supply of the normal biliary system and the collateral hilar plate arterial plexus forms the anatomical foundation for successful reconstructive surgery, not only in vasculobiliary injuries following cholecystectomy, but also for a wide range of hepatobiliary procedures.
RADIATION EXPOSURE DURING FLUOROSCOPY: SHOULD WE BE PROTECTING OUR THYROIDS?
Authors: Tse V. , Lising J. , Khadra M. , Chiam Q. , Nugent R. , Yeaman L. , Mulcahy M. 
Published: March 2003

Background: Recent reports on thyroid cancer among Australian orthopaedic surgeons prompted the present study which sought to evaluate the effectiveness of lead shielding in reducing radiation exposure (RE) to the thyroid region during endo‐urological procedures. Methods: Radiation exposure to the thyroid region of the surgeon and scrubbed nurse was monitored for 20 consecutive operations over a 6‐week period by thermoluminescent dosimeters (TLD). A TLD was placed over and underneath a thyroid shield of 0.5 mm lead equivalent thickness to monitor the effect of shielding. Results: Eight percutaneous nephrolithotomies, seven retrograde pyelograms and ureteric stentings and five ureteroscopies for calculous disease were monitored. Total exposure time was 63.1 min. For the surgeon, the total cumulative RE over and under the lead shield was 0.46 and 0.02 mSv, respectively, equating to a 23‐times reduction in RE if shielding was used. This effectively reduced RE to almost background levels, which was represented by the control TLD exposure (0.01 mSv). Conclusion: Although RE without thyroid shields did not exceed current standards set by radiation safety authorities, no threshold level has been set below which thyroid carcinogenesis is unlikely to occur. Because lead shields are easy to wear and can effectively reduce RE to the thyroid region to near‐background levels, they should be made easily available and used by all surgeons to avoid the harmful effects of radiation on the thyroid.
BREAST CANCERS INVISIBLE ON MAMMOGRAPHY
Authors: Foxcroft L. M. , Evans E. B. , Joshua H. K. , Hirst C. 
Published: March 2003

Background: A proportion of the cancers ‘missed’ at mammography are invisible even with the benefit of hindsight. The aim of the present study was to identify a group of women with proven breast cancer whose mammograms did not show a suspicious lesion even in retrospect (i.e. the truly mammographically occult cancers), and to compare them with mammogram‐positive cancers. Methods: A total of 1757 breast cancers was diagnosed at the Wesley Breast Clinic’s Screening or Diagnostic Services between July 1987 and August 1997. One hundred and twenty cases were identified where, after independent review by two of the authors, no mammographic abnormality could be found in the region where the cancer was subsequently found. These 120 cases were compared with 1548 cancers considered to have a lesion visible on mammography, whether benign, indeterminate, suspicious or malignant in appearance. Results: In 90% of the mammogram‐negative cancers, a clinical abnormality led to further investigation, while the remainder were found incidentally on ultrasound. There were a higher proportion of dense breasts, and of women aged 40–49, in the mammogram‐negative cancers than in the mammogram‐positive cancers. The mammogram‐negative cancers were of smaller size overall, but three of them were surprisingly large (7–11 cm). In both the mammogram‐positive and ‐negative cancers ~ 60% were ductal invasive cancers. Conclusions: Where factors are present that make mammographically occult malignancy more likely (e.g. age 40–49 and dense breasts), women may be targeted for further investigation by other modalities. This is essential in the presence of a clinical abnormality.
ROLE OF AXILLARY SURGERY IN EARLY BREAST CANCER: REVIEW OF THE CURRENT EVIDENCE
Authors: Spillane Andrew J. , Sacks Nigel P. M. 
Published: March 2003

Background: Controversy continues to surround the best practice for management of the axilla in patients with early breast cancer (EBC), particularly the clinically negative axilla. The balance between therapeutic and staging roles of axillary surgery (with the consequent morbidity of the procedures utilized) has altered. This is due to the increasing frequency of women presenting with early stage disease, the more widespread utilization of adjuvant chemoendocrine therapy and, more recently, the advent of alternative staging procedures, principally sentinel node biopsy (SNB). The aim of the present review is to critically analyse the current literature concerning the preferred management of the axilla in early breast cancer and make evidence‐based recommendations on current management. Methods: A review was undertaken of the English language medical literature, using MEDLINE database software and cross‐referencing major articles on the subject, focusing on the last 10 years. The following combinations of key words have been searched: breast neoplasms, axilla, axillary dissection, survival, prognosis, and sentinel node biopsy. Results: Despite the trend to more frequent earlier stage diagnosis, levels I and II axillary dissection remain the treatment of choice in the majority of women with EBC and a clinically negative axilla. Conclusions: Sentinel node biopsy has no proven superiority over axillary dissection because no randomized controlled trials have been completed to date. Despite this, SNB will become increasingly utilized due to encouraging results from major centres responsible for its development, and patient demand. Therefore if patients are not being enrolled in clinical trials strict quality controls need to be established at a local level before SNB is allowed to replace standard treatment of the axilla. Unless this is strictly adhered to there is a significant risk of an increase in the frequency of axillary relapse and possible increased understaging and resultant inadequate treatment of patients.
Absolute Risk of Breast Cancer for Australian Women with a Family History
Authors: Taylor Richard , Boyages John 
Published: March 2003

Background: The purpose of the present paper was to estimate the absolute risk of breast cancer over the remainder of a lifetime in Australian women with different categories of family history. Methods: Age‐specific breast cancer incidence rates were adjusted for screening effects, and rates in those with no family history were estimated using the attributable fraction (AF). Relative risks from a published meta‐analysis were applied to obtain incidence rates for different categories of family history, and age‐specific incidence was converted to cumulative risk of breast cancer. The risk estimates were based upon Australian population statistics and published relative risks. Breast cancer incidence was from New South Wales women for 1996. The AF was calculated using prevalence of a family history of breast cancer from data on Queensland women. The cumulative absolute risk of breast cancer was calculated from decade and mid‐decade ages to age 79 years, not adjusted for competing causes of death. Results: Lifetime risk is approximately 8.6% (1 in 12) for the general population and 7.8% (1 in 13) for those without a family history. Women with one relative affected have lifetime risks of 1 in 6–8 and those with two relatives affected have lifetime risks of 1 in 4–6. The cumulative residual lifetime risk decreases with advancing age; by age 60 years all groups with only one relative affected have well above a 90% probability of not developing breast cancer to age 79 years. Conclusions: These Australian risk statistics are useful for public information and in the clinical setting. Risks given here apply to women with average breast cancer risk from other risk factors.
Splenectomy of the fetal lamb early in development as a model for congenital asplenia
Authors: King Karen J. , Mccullagh Peter 
Published: March 2003

Background: The liability to overwhelming infection of children lacking a spleen either as a result of its congenital absence or because of splenectomy, has been frequently documented. Although there have been numerous studies of the consequences of experimental splenectomy in postnatal animals, this is the first study of the effects of this operation in early fetal life. Methods: A technique is described for microsurgical removal of the spleen from fetal lambs approximately one‐third of the way through gestation, when the fetus is approximately the size of a mouse. Lambs that had been splenectomized in utero were submitted to haematological examination in postnatal life and were challenged with pneumococcal polysaccharide to test their immunological competence. Results: Lambs in which splenectomy had been performed close to the gestational age of initiation of the splenic contribution to differentiation of immune and haemopoietic systems, exhibited insignificant deviations from normality in postnatal life. Conclusion: Provided the spleen is removed from the fetal lamb sufficiently early in gestation, it is possible for other lymphoid tissues to compensate for most of the deficiencies that would be anticipated in animals lacking a spleen. In this experiment, splenectomy was performed at approximately the developmental stage equivalent to that at which the spontaneous interruption of development that leads to human congenital asplenia occurs. The absence of major postnatal abnormalities observed in these lambs reinforces the significance of the associated abnormalities in the development of the clinical deficits observed in children with spontaneous asplenia.
Implementing guidelines about colorectal cancer: A national survey of target groups
Authors: Gattellari Melina , Ward Jeanette , Solomon Michael 
Published: March 2003

Background: An Australia‐wide postal survey was undertaken to determine surgeons’ attitudes towards guidelines and their preferred strategies for dissemination and implementation of guidelines for the management of colorectal cancer, developed by the Australian Cancer Network (ACN) and the Clinical Oncological Society of Australia (COSA). This survey was conducted as a baseline before the release of the definitive guidelines. Methods: All members of the Royal Australasian College of Surgeons (RACS) with a self‐nominated special interest in colorectal surgery and members of the Colorectal Surgical Society of Australia (CSSA) were surveyed. Results: A total of 195 of the 219 surgeons eligible for the study returned questionnaires (89% response rate). Most (86%) were aware that these guidelines were being developed. More than one‐half had read at least one draft version. Almost half (44.6%; 95%CI: 37.6–51.9%) agreed that guidelines represented ‘cookbook medicine’ and one‐third (33.3%; 95%CI: 26.9–40.5%) agreed that guidelines might increase the number of malpractice suits. Local adaptation of guidelines and ‘academic detailing’ were most favourably ranked to assure implementation. Further, 54.9% (95%CI: 47.6–61.9%) of respondents believed that a successful legal defence of a surgeon whose practice had been within the guidelines would encourage uptake. Surgeons operating outside teaching hospitals were more likely to endorse this view than others. Conclusions: These results demonstrate that an important target group for colorectal cancer guidelines, namely surgeons, appears receptive to clinical practice guidelines. These results could also permit interventions that target attitudinal barriers to implementing guidelines and subgroups of surgeons who have particular concerns. Expensive strategies for implementation ought to be subject to rigorous evaluation for their impact in modifying clinical practice.
Cronic radiation proctitis
Authors: Tagkalidis Peter P. , Tjandra Joe J. 
Published: March 2003

Background: Increasing use of radiation therapy in pelvic malignancy has led to an increase in the incidence of chronic radiation proctitis. The commonest presenting complaint is rectal bleeding. Methods: A comprehensive MEDLINE search was undertaken for all articles relating to radiation proctitis. Results: The natural history of the disease is poorly documented but improvement is likely in milder forms, with persistence of symptoms in more severe forms. The pathological manifestations of the disease are summarized with particular comparison to acute radiation proctitis. The common clinical presentations and the principles of assessing patients with radiation‐induced proctitis will be reviewed. The present article also reviews current treatment options, with particular reference to newer endoscopic therapies and surgical principles of management. Conclusions: The initial therapy for problematic rectal bleeding related to radiation‐induced proctitis shoud be endoscopic therapy with argon plasma coagulation or topical formalin therapy. Surgery is reserved as a last resort for resistant rectal bleeding and for complicated radiation‐induced strictures and fistulas.
Diagnostic accuracy of vacuum‐assisted biopsy device for image‐detected breast lesions
Authors: Hung Wai‐Ka , Lam Hon‐Shing , Lau Yvonne , Chan Chi‐Mui , Yip Andrew Wai‐Chun 
Published: March 2003

Background: Non‐palpable breast lesions present diagnostic difficulties. Ultrasound‐guided fine‐needle aspiration cytology (FNAC) is a common method used to obtain a diagnosis, but FNAC is frequently inconclusive or insufficiently accurate. Recently a vacuum‐assisted biopsy device (Mammotome®, Ethicon, Endo‐surgery, USA) has been introduced. The diagnostic accuracy of this biopsy device was assessed for lesions that were visible on ultrasound. Methods: Fifty ultrasound‐guided mammotome biopsies were performed. All were small breast lesions primarily detected by ultrasound. All received FNAC as initial assessment. Mammotome biopsy was performed whenever the breast lesion was considered indeterminate or if it was considered benign and there were associated risk factors such as a family history of breast cancer. Results: Of 50 mammotome biopsies 45 had benign histology. Three of 45 lesions were excised at the patients’ request and were confirmed to be benign. The remaining 42 patients received an ultrasound follow up at 6 months. The lesion size remained static in 39 patients. In three patients the lesion size increased and they were excised and histology was benign. For the four malignancies diagnosed with mammotome biopsy, three patients received definitive treatment and one patient defaulted. There was one failed mammotome biopsy in the present series. Conclusions: Mammotome biopsy is an acceptable diagnostic method for small breast lesions seen on ultrasound. It reduces the need for open biopsy without compromising diagnostic accuracy.
Twin ectopic pregnancy 10 years after permanent sterilization
Authors: Ansari Selim M. , Nessa Lutfun , Saha Samiran K. 
Published: March 2003

SUMMARYAn ectopic twin pregnancy was reported in a 37‐year‐old woman with a history of tubectomy for permanent sterilization 10 years earlier. Ectopic pregnancy is common, but twin ectopic pregnancy is a rarer case.