bluuebunny/crossref_metadata_2025_split huggingface dataset:
Women’s choice between sentinel lymph node biopsy and axillary clearance
Authors: Gan Steven , Magarey Christopher , Schwartz Peter , Papadatos George , Graham Peter , Vallentine Jane 
Published: March 2003

Purpose: To determine whether women would choose sentinel lymph node biopsy (SLNB) or axillary clearance (AC) for breast cancer treatment when they are given a single choice based on clear information about morbidity and mortality. Methods: The expected 5‐year survival rate of women with breast cancer after either SLNB or AC was calculated using a utility analysis of established literature. The difference in survival was one in 1000. This and other detailed information on SLNB and AC was presented in a questionnaire, which provided subjects with a scenario and a choice between SLNB and AC. After a pilot study of 40 subjects, the questionnaire was mailed to 400 women (who had no mammographic abnormality) attending Breast Screen and handed to 100 women (who were over 40 years of age and had breast symptoms but not cancer) attending the rooms of two surgical specialists. Results: One hundred and twenty one of the 243 respondents to the mailed questionnaires (49.8%) chose SLNB and 35% of the 100 consulting room subjects chose SLNB rather than AC. Conclusions: Women faced with the possibility of having breast cancer seem to be very conservative in their choice of treatment, many choosing the increased morbidity of AC rather than the very small (one in 1000) increased risk of death at 5 years from SLNB. This raises questions about proposals to offer SLNB as standard treatment and demands that women are fully informed about any increased risk of death when making their choice between SLNB and AC.Abbreviations: AC, axillary clearance; SLNB, sentinel lymph node biopsy.
Minimally invasive parathyroidectomy using the ‘focused’ lateral approach. I. Results of the first 100 consecutive cases
Authors: Agarwal Gaurav , Barraclough Bruce H. , Robinson Bruce G. , Reeve Tom S. , Delbridge Leigh W. 
Published: March 2003

Background: A feasibility study of ‘focused’ minimally invasive parathyroidectomy (MIP) using a lateral approach was commenced in 1999. The aim of the present paper was to evaluate the effectiveness and safety of this procedure in the first 100 consecutive patients. Methods: This was a prospective, non‐randomized case‐control study. One hundred consecutive patients with primary hyperparathyroidism (mean age 63.1 years; 74 females, 26 males) who fulfilled the inclusion criteria underwent focused MIP between May 1999 and December 2000. The results for the first and last 50 consecutive patients were compared to see whether they were reflective of a learning curve. The role of intraoperative quick parathyroid hormone (QPTH) estimation was also evaluated. Results: Focused MIP was successfully completed in 93 of 100 patients, with seven conversions. Three (3.2%) of the 93 patients had persistent hyperparathyroidism. Quick PTH was measured in 81 patients and the results were true positive (for cure) in 72 patients, false negative in six patients, true negative in two patients and false positive in one patient. Transient recurrent laryngeal nerve paresis occurred in one patient. During the same time period, open parathyroidectomy was performed in 242 patients. The results were not different between the first and later 50 patients undergoing MIP, nor were the outcomes significantly different from patients undergoing open parathyroidectomy. Conclusions: Focused MIP is a safe and effective operative approach for appropriately selected patients. Failed procedures were invariably related to shortcomings of the localization studies. Measurement of QPTH, although accurate, is unreliable in the presence of multigland disease.
Malignancies of the external auditory canal and temporal bone: A review
Authors: Yeung P. , Bridger A. , Smee R. , Baldwin M. , Bridger G. P. 
Published: March 2003

Background: Malignancies of the external auditory canal and temporal bone are uncommon. A retrospective review was conducted of a large series treated at the Prince of Wales hospital between 1974 and 1995. Methods: Retrospective review of 59 cases of ear canal and temporal bone malignancies. These were analysed according to histopathology, disease extent, surgery, margin status and survival. A TNM‐type staging system was applied to 51 cases and Kaplan–Meier survival analysis applied to this group. Results: The 5‐year cancer‐specific survival (CSS) for the series was 54%. For stages 1, 2, 3 and 4 disease, the CSS were 90, 45, 40 and 19%, respectively. Survival was significantly higher where clear surgical margins were achieved (80 vs 35%). Conclusions: Carcinoma of the external ear canal is rare and, in Australia, is often related to recurrence of periauricular cutaneous malignancy. Surgical extirpation with clear margins provides the best survival.
Assessment of myocardial injury by troponin T in off‐pump coronary artery grafting and conventional coronary artery graft surgery
Authors: Bennetts Jayme S. , Baker Robert A. , Ross Iain K. , Knight John L. 
Published: March 2003

Purpose: The present study was undertaken to assess the degree of myocardial injury, using troponin T (TnT), in off‐pump coronary artery surgery (OPCAB) and in a comparable patient group undergoing conventional coronary artery graft surgery (CABG). Methods: Twenty‐seven OPCAB and 27 CABG patients were investigated. Blood samples for TnT were taken at intubation and at 12, 24 and 72 h. Nine patients (five OPCAB, four CABG) underwent 2 h sampling for 12 h for the assessment of the TnT release profile. All patients had an electrocardiogram performed preoperatively and on the mornings of days 1 and 5 postoperatively. Results: The OPCAB group had significantly greater Canadian Heart Classification 3 patients (P = 0.003); however, other demographic data were similar between the two groups. All patients had normal TnT at initial sampling. The mean number of grafts in each group was 1.8 ± 0.6 for OPCAB and 1.9 ± 0.3 for CABG (P = NS). There were two new Q wave myocardial infarctions in the CABG group and none in the OPCAB group. These cases were excluded from biochemical analyses. Troponin T release was significantly less in the OPCAB group at 12 and 24 h (P < 0.001 and P = 0.03, respectively). Peak TnT release occurred at 6–8 h in both groups. Troponin T release was significantly lower in the OPCAB group at 2, 4, 6, 8, 10 and 12 h (P = 0.01, P = 0.03, P = 0.02, P = 0.02, P = 0.03 and P = 0.04, respectively). Postoperatively, the OPCAB group required less blood transfusion (P = 0.02). Conclusions: The OPCAB group demonstrated a significantly reduced TnT release profile compared with the CABG group.
Primary hyperparathyroidism: Referral patterns and outcomes of surgery
Authors: Flint Richard S. , Harman Christopher Richard , Carter Jim , Snyman Gerrie 
Published: March 2003

Background: Parathyroidectomy has long been established as an effective treatment for primary hyperparathyroidism (HPT). Methods: A 15‐year retrospective audit was made by surgeons at North Shore Hospital, Auckland, of 33 patients with primary HPT who had parathyroidectomy. Results: There were 22 females and 11 males, ranging in age from 18 to 77 years (median 63 years). Initial diagnosis was predominantly by a general practitioner (72%), who invariably referred to a physician. Referral to surgery was made by general physicians (55%), endocrinologists (33%) and geriatricians (6%). Delay between diagnosis and referral for surgery ranged from 8 days to 10 years (median 7 months), and exceeded 2 years in 24% of patients. Twenty‐eight (85%) were symptomatic: 13 (39%) had renal symptoms, 13 (39%) had bone disease, 10 (31%) had gastrointestinal complaints, seven (21%) had psychiatric illnesses and six (18%) had fatigue. The high incidence of symptoms was matched by high biochemical values (mean serum cal‐ cium level 2.97 mmol/L), and large parathyroid glands (mean weight 2001 mg). Twenty‐nine patients (88%) had single adenomas, two (6%) had chief cell hyperplasia and two (6%) had carcinoma. Thirty‐one (94%) were cured of their primary HPT. Conclusions: Parathyroidectomy is a safe and effective treatment for primary HPT but depends upon referral from non‐surgical clinicians. A large proportion of patients have long delays before their surgery, and the group selected for surgery is referred with severe disease.
131I lipiodol therapy for unresectable hepatocellular carcinoma
Authors: Rindani Rahoul B. , Hugh Thomas J. , Roche James , Roach Paul J. , Smith Ross C. 
Published: March 2003

Background: More than 80% of hepatocellular carcinoma tumours (HCC) are unresectable at presentation because of the multicentric nature of the disease or the severity of liver disease. Arterially administered lipiodol is preferentially retained by HCC and has been used as a vehicle for delivery of therapeutic agents to the tumour. The aim of this phase I study is to present the experience with 131I‐labelled lipiodol in the treatment of unresectable HCC. Methods: 131Iodine lipiodol treatment was administered to 12 patients with unresectable HCC between 1994 and 1999. The outcome of treatment in these patients was evaluated for survival, clinical tolerance, liver function tests, α‐fetoprotein (AFP) levels and changes in tumour size on computed tomography (CT) scans. Results: Ten of the 12 patients received more than one 131I treatment. Five patients had treatment for post‐resection recurrence. Serum AFP levels dropped initially in five of the seven patients with elevated values. Tumour size, evaluated by CT scans at 3 months, decreased in six patients and remained stable in the rest, except one patient in whom both the AFP level and tumour size had increased. Using life table analysis, the 50% survival was 19 months. Conclusions: Intra‐arterial 131I treatment was very well tolerated. A reduction in AFP levels and tumour size occurred in half of the patients and resulted in a 50% probability of survival of 19 months. Further examination of the value of this treatment in phase II and III studies is required.
Postdischarge clean wound infections: Incidence underestimated and risk factors overemphasized
Authors: Reid Richard , Simcock Jeremy W. , Chisholm Linda , Dobbs Bruce , Frizelle Frank A. 
Published: March 2003

Background:  Wound infections are a leading cause of postoperative morbidity and a cost to both the individual and community. The surgeon now has a reduced appreciation of wound‐infection rates because of shorter hospital stays and an increasing reliance on the primary care physicians. The incidence of wound infections which occurred following clean surgical procedures, as well as whether they could have been predicted by the known risk factors, were analysed in the present prospective study.Methods:  A prospective audit of the first 30 postoperative days following clean general surgical wounds was undergone, with inpatient assessment by a research nurse, and subsequent outpatient follow up by patient telephone interview.Results:  Of 1964 clean wounds over a 30‐month period, 98.5% were
traced. The overall clean‐wound infection rate was 12.6% (inpatient:
4.5%; outpatient: 8.1%). Inpatient infection rates
(but not postdischarge wound‐infection rates) were significantly
cor­related (P < 0.05) to the American Society of Anesthesiologists’ rating, operation duration, preoperative day stay, and age. Infection rates varied with operation type: vascular (18.3%), breast (16.0%), abdominal (10.3%), hernia (8.0%), head and neck (7.1%).Conclusions:  The overall wound‐infection rate is higher than previously described with two thirds of infections occurring after discharge. While inpatient wound‐infection rates fit known risk factors, postdischarge wound‐infection rates do not. Certain clean‐wound operations have a higher incidence of infection than others. Consideration needs to be given to the identification of risk factors for postdischarge wound infections, and to further trials of prophylactic antibiotics in clean surgery.
Changing patterns of pharmacological thromboprophylaxis use by orthopaedic surgeons in New Zealand
Authors: Walker Natalie , Rodgers Anthony , Gray Harley 
Published: March 2003

Background:  A survey conducted in 1992 found that New Zealand orthopaedic surgeons relied on non‐pharmacological methods of deep vein thrombosis prevention in most arthroplasty patients and almost all hip fracture patients. This survey was repeated in 1999 to ascertain whether this pattern of use had changed.Methods:  All orthopaedic consultants in New Zealand who performed hip or knee surgery in 1999 were asked to complete a one‐page postal questionnaire, asking for information regarding: the frequency with which chemoprophylaxis was employed in patients undergoing surgery for hip fracture, hip arthroplasty, or knee arthroplasty; the drug regimes used; the factors that influenced the choice of chemoprophylaxis; and the factors that limited chemoprophylaxis use in orthopaedic practice.Results:  Between 1992 and 1999, the proportion of patients given chemoprophylaxis increased from 3% to 25% for patients with hip fracture, and from 32% to 57% for elective arthroplasty patients. The proportion of surgeons using low molecular weight heparin increased over the 7‐year period from 55% to 76%, while aspirin use remained stable at 7% and standard heparin and warfarin decreased to less than 5%. There was a shift away from starting chemoprophylaxis preoperatively towards continuing until discharge, rather than until the patient was mobile. Opinions on indications and contraindications for chemoprophylaxis had not changed substantially during the 7‐year period.Conclusions:  Orthopaedic surgeons’ use of chemoprophylaxis has increased in New Zealand. However, since hospital stays have decreased considerably and most orthopaedic patients are now discharged within a fortnight, prophylaxis may now cover a shorter duration of the at‐risk period.
Stenting for obstructing colorectal malignancy: An interim or definitive procedure
Authors: Vrazas John I. , Ferris Scott , Bau Shan , Faragher Ian 
Published: March 2003

Background:  The purpose of this paper is to review and report our experience with colorectal stenting in the management of malignant large bowel obstruction.Methods:  Twelve consecutive patients with malignant left‐sided large bowel obstruction between June 1998 and January 2001 underwent insertion of self‐expanding metallic stents. One patient required two stents. Eight stents were inserted under fluoroscopic guidance, and five were inserted with combined fluoroscopic and endoscopic guidance. Patients were followed up until death, stent removal or the time of publication.Results:  Thirteen stents were inserted. Eleven patients with acute large bowel obstruction had relief of obstruction with stenting, and one of these patients required a second stent because relief had been incomplete. One patient was stented in order to sub­sequently close a problematic stoma. Technical success was 92.9% and clinical success was 100%. Three patients proceeded to surgical resection. In nine patients, the stent was left as the definitive procedure. Of these, six patients have died within 4 months. Complications included one case of migration, one case of reobstruction, one intestinal haematoma and one case of cheesewiring.Conclusions:  Colorectal stenting is an important treatment modality for malignant large bowel obstruction. It may be definitive treatment alone, or a bridge to elective surgical resection.
Treatment of acute malignant colorectal obstruction with self‐expandable metallic stents
Authors: Wong Kutt Sing , Cheong Denis Mun Onn , Wong Daniel 
Published: March 2003

Background:  Malignant left‐sided large bowel obstruction from intraluminal and extrinsic causes constitutes a surgical emergency. When conservative measures fail, emergent surgery is usually required, which carries increased morbidity and mortality compared with elective resections. In many situations, a stoma is created and further surgery may be required later to re‐establish bowel continuity. We present an initial series of patients in whom self‐expandable metallic stents (SEMS) were deployed to allow bowel decompression in place of emergency surgery for acute left‐sided colorectal obstruction.Methods: From April 1999 to January 2001, patients who were admitted to the colorectal unit with clinical and radiological features of intestinal obstruction were considered for endolumenal stenting. Stenting was performed under radiological guidance.Results:  Sixteen patients underwent endolumenal stenting (age range: 23−90 years, eight men and eight women). There were two technical failures, two delayed perforations and one sealed perforation related to the stent. Three patients underwent elective resection and anastomosis after successful bowel decompression and mechanical bowel preparation. Eight patients with advanced malignancy or multiple medical disease had good bowel decompression after stent deployment and did not undergo any surgery.Conclusion:  SEMS is a useful alternative in the management of acute left‐sided colorectal obstruction for a select group of patients. An algorithm for management of acute left‐sided large bowel obstruction incorporating the use of SEMS is proposed.
Laparoscopic adrenalectomy: A 6‐year experience of 59 cases
Authors: Pillinger Stephen H. , Bambach Christopher P. , Sidhu Stan 
Published: March 2003

Background:  The aims of this paper were to review our experience with laparoscopic transperitoneal adrenalectomy, report on outcomes in comparison with the published literature, and demonstrate any learning curve with the technique.Methods:  A review of our database and patient records was carried out for the period April 1995 to December 2000. Patient demographics, tumour characteristics, operating times, outcomes and lengths of stay were studied. Diagnostic tools, including a comparison between tumour size on computed tomography scanning and on pathological section were reviewed. A comprehensive literature review was conducted using MEDLINE.Results:  Indications for surgery included 33 patients with primary hyperaldosteronism (29 adenomas, 4 hyperplasias), 12 phaeochromo­cytomas, 7 cortisol‐secreting adenomas, 4 non‐secreting adenomas, 1 medullary cyst, 1 metastasis and 1 ganglioneuroma. The tumours ranged in size from 7 to 110 mm. All tumours were localized and lateralized preoperatively using standard techniques. Throughout the review period, six open procedures were undertaken electively, for various reasons. Three cases were converted to open procedures (5.1%). Thirty‐eight left and 21 right procedures were undertaken. For all laparoscopic procedures, the average time in the operating theatre was 175.1 min. Men took 188.3 min compared with 165.7 min for women. Left‐sided lesions took 178.72 min compared with 167.63 min for right‐sided lesions. The average length of stay was 3.8 days. There was one wound infection, one blood transfusion and two readmissions: one for pain control in a patient with difficult home circumstances, and one patient suffered transient hypoadrenalism.Conclusion:  The results achieved in our initial experience with this technique are comparable with the published literature. The results confirm that laparoscopic adrenalectomy is the method of choice for resection of benign adrenal pathology. The procedure has a learning curve and should be performed by a surgeon experienced in both open and laparoscopic adrenal surgery.
Reduced use of drains following axillary lymphadenectomy for breast cancer
Authors: Talbot Michael Leonard , Magarey Christopher John 
Published: March 2003

Background:  Axillary dissection is frequently performed during the treatment of operable breast cancer, and is associated with certain morbidities. Accumulation of axillary fluid, otherwise known as a seroma, is a frequent complication that appears to be related to the degree of dissection. Based on empirical evidence, surgeons have attempted to reduce the occurrence and duration of seromas by using suction drainage, but this concept has been challenged by several authors.Objectives:  To determine if the natural history of seroma fluid accumulation after axillary surgery is altered by the duration of suction drainage or non‐placement of a drain.Methods:  Ninety consecutive patients having axillary dissection for breast cancer had either prolonged suction drainage (mean 9.6 days), short duration drainage (2 days), or had no drain placed. Seromas were aspirated and the time to cessation of fluid accumulation determined, as well as any other wound complications.Results:  There was no difference in the number of wound complications or the duration of fluid accumulation between the three groups, being 26.6, 25.7, and 27.9 days, respectively. Patients having no drains placed required more frequent aspirations.Conclusions:  The duration of seroma fluid accumulation is not altered by the placement of a suction drain following axillary lymphadenectomy.
Technical developments and a team approach leads to an improved outcome: Lessons learnt implementing laparoscopic splenectomy
Authors: Chan Sorway W. , Hensman Chris , Waxman Bruce P. , Blamey Stephen , Cox John , Farrell Ken , Fox Jane , Gribbin John , Layani Laront 
Published: March 2003

Background:  To document the technical aspects, outcome and lessons learnt during the learning curve phase of implementing laparoscopic splenectomy, by comparing the results before and after the introduction of a standardized technique.Methods:  We present a retrospective and prospective review of laparoscopic splenectomies over a 4‐year period. Two chronological periods were studied, before and after the implementation of a standardized technique of a laparoscopic splenectomy involving: (i) hilar dissection with ultrasonic shears; (ii) two experienced laparoscopic surgeons; and (iii) trained dedicated equipment and staff using a checklist approach in the preparation and conduct of the operation. Two groups of patients were studied relating to the periods before and after the implementation of a standardized technique. Statistical methods used were the Wilcoxon's rank sum test and the two‐sample test.Results:  Thirty‐one laparoscopic splenectomies were attempted. The most common indication was for idiopathic thrombocytopenic purpura. When comparing the early phase (n = 15) with the standardized technique phase (n = 16), there was a significant reduction in conversion rates (40% vs 6%), operating times (218 min vs 171 min), complication rates (6 cases including 1 death vs none) and length of stay (11 days vs 4 days). The results were significant for reduction in hospital stay, conversion rates and complications rates.Conclusions:  A reduction in conversion rates, operating time, morbidity and length of stay was realized during the learning curve of implementing laparoscopic splenectomy by adopting a standardized technique. This technique involved hilar dissection using the ultrasonic shears, two experienced laparoscopic surgeons performing the surgery, dedicated equipment and trained staff using the checklist approach. We recommend such a standardized technique in performing laparoscopic splenectomy.