bluuebunny/crossref_metadata_2025_split huggingface dataset:
Idiopathic chondrolysis of the hip: medium‐ to long‐term results
Authors: Korula Ravi Jacob , Jebaraj Isaac , David Kenny S. 
Published: September 2005

Background:  Chondrolysis of the hip secondary to severe trauma, prolonged immobilization and slipped capital femoral epiphysis have been well documented. There have not been many reports, however, of idiopathic chondrolysis of the hip. We here present our experience with 21 hips with an average follow‐up of 23.4 months.Methods:  Twenty patients (21 hips), with gross deformities of the hip who presented with fibrous ankylosis were treated over a 23‐year period. Average age at presentation was 13 years. None of the patients responded to a trial of conservative treatment (non‐steroidal anti‐inflammatory medications, traction and physiotherapy.)Results:  Most of the preoperative deformities were corrected following arthrotomy, capsulectomy and skeletal traction. However, return of normal hip motion was not seen in any of the patients. Fibrous ankylosis in a functional position was seen to develop in two patients; one patient underwent hip arthrodesis, while another with bilateral involvement underwent excision arthroplasties.Conclusions:  Circumferential capsulectomy with aggressive mobilization of the hip can correct the deformities associated with this condition, although long‐term results are uniformly disappointing with regard to return of hip joint motion in cases of late presentation.
Complications and outcomes of single‐stage bilateral total knee arthroplasty
Authors: Horne Geoffrey , Devane Peter , Adams Kathryn 
Published: September 2005

Background:  A recent literature review by the senior authors of this study revealed that simultaneous bilateral knee arthroplasty is uncommon and controversial. Reported complications include myocardial infarction, deep venous thrombosis, pulmonary embolus, thromboembolic complications, pseudo‐obstruction, postoperative ileus and death. This present study was designed to identify complications of single‐stage bilateral total knee arthroplasty to compare with reports in the international literature.Methods:  A retrospective study of 40 cases of simultaneous total knee arthroplasty carried out by the senior authors at Wellington over the last 10 years, examined details of surgery, anaesthesia, preoperative and postoperative management to identify the occurrence of complications. Thirty‐one patients completed an Oxford Knee Score, a EuroQuol‐5 Dimension (EQ‐5D) questionnaire and reported their experience of the bilateral procedure.Results:  Complications reported in the international literature did not occur in the patients studied. Complications that did occur included urinary retention, wound infections and oedema of the limbs or knees. The mean Oxford Knee Score was 20.79. In 2003 the New Zealand national mean for primary total knee arthroplasty was 23.35. The EQ‐5D revealed high patient satisfaction and good functional status.Conclusions:  While the outcomes and cost benefits of single stage bilateral replacement are established, the risk of complications remains. This study establishes the low complication rate associated with this procedure in the senior authors’ hands, and documents the high patient satisfaction. The study demonstrates that, in selected patients, simultaneous bilateral knee replacement surgery can be performed with good outcomes without a definite increase in perioperative risk.
Surgical management of invasive breast cancer: a 5‐year prospective study of treatment in the Australian Capital Territory and South‐Eastern New South Wales
Authors: Koshy Anil , Buckingham John M. , Zhang Yanping , Craft Paul , Dahlstrom Jane E. , Tait Members of the ACT and SE NSW Breast Cancer Treatment G Noel 
Published: September 2005

Background:  Breast cancer is a major health problem in Australia. The aim of the present report is to evaluate the surgical management of invasive breast cancers in our region.Methodology:  As part of a multidisciplinary quality assurance project, data were collected for the majority of breast cancers treated in our region between July 1997 and June 2002. Participants included surgeons, medical and radiation oncologists, pathologists and general practitioners.Results:  Over the 5‐year period, 1069 invasive breast cancers were treated. Mastectomy (52%) was more common than breast conservation. For cancers less than 2 cm in diameter (61%), breast conservation was achieved in 62%. High nuclear grade cancers (27%) resulted in mastectomy in 60%. This treatment pattern was the same for patients living in urban and rural areas and in all age groups. Those patients requiring two or more operations (30%) to achieve surgical clearance still had a 33% rate of breast conservation. Over the last 5 years there has been an increase in sentinel node biopsies (16 sentinel node biopsies during 1998−1999; 64 during 2001−2002) and axillary dissections started to decrease. A small group has had no axillary node biopsy or dissection, mainly patients over 70 years of age. Multimodality treatments increased over the 5‐year period of our study with the use of postoperative radiotherapy increasing from 60% to 65% and chemotherapy from 36% to 55%.Conclusions:  The project has mapped treatment trends for breast cancer in our region and documented the implementation of new treatment methods as well as the increasing use of multidisciplinary management, multimodality treatment and the implementation of best practice guidelines.
Is age at diagnosis an independent prognostic factor for survival following breast cancer?
Authors: Jayasinghe Upali W. , Taylor Richard , Boyages John 
Published: September 2005

Background:  Previous studies of patients with breast cancer have examined age at diagnosis as a prognostic factor for survival with contradictory results. The current study examines the effect of age in conjunction with pathological tumour size, lymph node status and histological grade to clarify whether age at diagnosis is an independent factor for overall survival.Methods:  This is a population‐based study that examines the survival of 393 women with a first diagnosis of breast cancer in 1992 in the Greater Western region of Sydney in New South Wales, Australia. Survival analysis was conducted using the Kaplan−Meier method. Relative risks associated with age at diagnosis, pathological tumour size, and number of positive lymph nodes and histological grade and adjusted for each other were computed using Cox proportional hazard regression. Patients’ ages were categorized as ‘younger’ (<40 years of age at diagnosis), ‘middle‐aged’ (40−69 years) or ‘older age’ (>69 years).Results:  The 10‐year survival of women <40 years was 49%, which was significantly lower than ‘middle‐aged’ women (73%). For women with node‐negative breast cancer, younger women had a significantly (P = 0.011) poorer survival rate (68%) than middle‐aged (90%) or older women (80%). After adjusting for the effects of the pathological tumour size, the lymph node status and histological grade, women <40 years showed a higher risk of dying than older women. However, young women detected with a small (<20 mm) node‐negative tumour have a good prognosis.Conclusions:  Age at diagnosis, tumour size and lymph node status were independent prognostic indicators for survival. Age at diagnosis should be considered as an important factor in making decisions about adjuvant therapy, irrespective of nodal status.
Safety and cost benefits of bilateral total knee replacement in an acute hospital
Authors: Stubbs Geoffrey , Pryke S. E. R. , Tewari Sandeep , Rogers Janine , Crowe Bethany , Bridgfoot Lynnet , Smith Natalie 
Published: September 2005

Background:  Total knee arthroplasty of both knees under the one anaesthetic has become a common procedure. Benefits reported include a shorter overall hospital stay and reduced costs. The published studies come from university associated tertiary referral hospitals with well‐established research establishments and a vast experience of joint replacement. This study examines the experience of a small hospital to see if similar benefits can be achieved.Methods:  A retrospective medical record review was performed of the synchronous bilateral knee replacements against a match group of bilateral staged knee replacements. Both groups were compared with a control group of unilateral knee replacements. A prospectively conducted review of the synchronous and staged bilateral knee replacement groups was then carried out to assess the clinical outcome in these two groups.Results:  The incidence of surgical and medical complications was not statistically different in any group. The bed stay for bilateral surgery was increased by 2 days compared to unilateral surgery with a net saving of 6 days hospital stay for the patient group having both knees replaced at separate operations within 1 year. At an average of 2.5 years post surgery there was no statistically significant difference in outcome between those patients who had both knees replaced either synchronously or at staged intervals.Conclusions:  Bilateral knee replacement is a good choice for patient and hospital. Bilateral surgery does not increase the risk of perioperative complications to the patient and reduces the overall cost to the hospital. There is no difference in short to medium term clinical outcome between patients who have had both knees replaced synchronously or at staged intervals. Results comparable in safety, as judged by complication rates and efficiency, as judged by length of stay can be achieved in a smaller metropolitan level 2 hospital environment.
Simultaneous branchial cleft and thyroid disorders may present a management challenge
Authors: Harding Jane L. , Veivers David , Sidhu Stan B. , Sywak Mark S. , Shun Albert , Delbridge Leigh W. 
Published: September 2005

Background:  Cysts, sinuses or abscesses arising from second, third or fourth branchial cleft remnants may lie either within the body of, or in close proximity to the thyroid gland. Given their infrequent nature they may pose both diagnostic and management challenges for the treating surgeon when they occur in association with thyroid disorders.Methods:  This is a case series. All patients with concomitant thyroid disorders and a branchial cleft anomaly treated in the University of Sydney Endocrine Surgical Unit in the 10‐year period 1994−2003 comprised the study group. Patient demographics, clinical presentation, imaging, surgical management, definitive histology and outcomes were documented.Results:  Six patients were identified with an age range of 3−76 years and a male : female ratio of 1:5. Five branchial cleft anomalies were left sided, one was right sided. Two patients had second cleft anomalies, both of which were initially thought to represent metastatic lymph nodes in association with thyroid cancer. A further two patients had third cleft abnormalities presenting as suppurative thyroiditis. The final two patients had fourth cleft abnormalities causing intraoperative management problems.Conclusions:  Branchial cleft remnants and anomalies are rare but may occur in association with thyroid disease. They may pose a diagnostic and management dilemma either preoperatively, when mistaken for metastatic thyroid cancer, or intraoperatively when mistaken for a thyroid nodule.
Long‐term outcome of postanal repair in the treatment of faecal incontinence
Authors: Abbas Saleh M. , Bissett Ian P. , Neill Mischell E. , Parry Bryan R. 
Published: September 2005

Background:  Idiopathic faecal incontinence is a common debilitating problem; the results of surgical treatment are variable with only a small proportion of patients achieving full continence.Objectives:  The aim of this study was to evaluate the long‐term outcome of postanal repair in idiopathic faecal incontinence.Patients and methods:  Patients who had postanal repair in Auckland between 1994 and 2001 were identified and mailed faecal incontinence severity index (FISI) and faecal incontinence quality of life (FIQOL) questionnaires. Preoperative and postoperative incontinence scores were compared and postoperative quality of life scores were calculated.Results:  Forty‐seven of the 66 patients who had undergone postanal repair from 1994 to 2001 completed the FIQOL questionnaire. FISI scores were complete on 44 patients. Comparison of preoperative and postoperative FISI scores revealed an improvement with mean scores of 34 and 23, respectively (P = 0.0001). Thirty (68%) patients had improved, including four who were fully continent. Fourteen patients were the same or worse.Conclusions:  Postanal repair provides lasting benefit for the majority of patients with faecal incontinence.
Improvement in the emergency splinting of fractures after a simple educational exercise
Authors: Miller Nicholas J. K. , Wong Wicky C. F. , Ryan Damien P. 
Published: September 2005

Background:  Splinting long bone fractures in the early stages of their management reduces pain, facilitates transport and helps prevent further soft tissue injury; but experience suggests that the rate of splinting is low. This study set out to quantify this rate and determine whether it could be improved with simple educational intervention.Methods:  Radiographs ordered in the emergency department over an 8‐week control period were examined for fractures and presence of splints. The junior doctors responsible for these patients completed a questionnaire to assess how highly they rated early splinting. At the beginning of the next emergency term new junior doctors were given the same questionnaire followed by an information sheet relating to fracture management. The questionnaire was repeated after reading the information sheet to confirm comprehension. Radiographs performed over the following 8 weeks were examined.Results:  Ninety‐six long bone fractures amenable to splinting were X‐rayed in the control period, and of these 15 were splinted (16%). After the intervention this rose to 28 out of 98 fractures (29%, P < 0.05). The intervention group prior to reading the information sheet ranked splinting in a similar manner to the control group (P > 0.20) but significantly higher afterwards (P < 0.01).Conclusion:  The rate of splinting of long bone fractures in the early stages of their management is low, and junior doctors do not regard this as a priority. We have shown that a simple teaching session significantly improves this rate and suggest that similar training should be provided to all emergency staff.
Surgical management of colorectal cancer in south‐western Sydney 1997−2001: a prospective series of 1293 unselected cases from six public hospitals
Authors: Wong S. K. Cyril , Kneebone A. , Morgan Matthew , Henderson Christopher J. A. , Morgan Ann , Jalaludin Bin 
Published: September 2005

Background:  The aim of the present study is to provide local data for the management of colorectal cancers in the south‐western Sydney health area from 1997 to 2001.Methods:  The data were collected prospectively. Follow up was conducted in late 2001 and early 2002. Data were cross‐validated with hospital and area databases and with data from the New South Wales Registry of Births, Deaths and Marriages.Results:  This was an unselected series of 1293 patients from 36 surgeons; 16.5% of patients presented as emergencies. Only 3% presented as a result of bowel cancer screening. Of the 1293 patients, 1270 received an operation. There were 598 elective colonic resections with the mortality rate of 1.2%, reoperation rate of 2.7% and anastomotic leak rate of 0.8%. For the 410 elective rectal resections, the rates were 2.9%, 2.7% and 1.2%, respectively. For the 290 emergency operations, the rates were much worse at 7.7%, 6.6% and 4.8%, respectively. The corrected overall 3‐year survival rate was 64%. For Dukes’ A, B, C and D, the figures were 94%, 87%, 61% and 7%, respectively.Conclusions:  Colorectal cancer is a major cause of mortality and morbidity in our community. Very few bowel cancers were discovered at the asymptomatic stage. This paper strongly supports community bowel cancer screening and early diagnosis. The local database has provided a rich source of information to benchmark management and outcomes of bowel cancer patients treated in the South Western Sydney Area Health Service. An area‐wide computer network with online data input facilities at individual workplaces will improve data integrity and data collection efficiency.
Limy bile syndrome: review of seven cases
Authors: Ballas Konstantinos D. , Alatsakis Michael B. , Rafailidis Savas F. , Psarras Kiriakos , Sakadamis Athanassios K. 
Published: September 2005

Background:  Milk of calcium bile or limy bile is a rare disorder in which the gall bladder is filled with a thick, paste‐like, radiopaque material.Methods:  Seven patients with limy bile syndrome were treated in our department from 1980 to 2003. There were five women and two men, and their age ranged from 30 to 64 years. A retrospective analysis of clinical symptoms, diagnostic work‐up, treatment approach and operative findings was performed.Results:  All patients presented with intermittent right upper abdominal quadrant pain. Three of the seven patients (42.85%) presented with complications like acute cholecystitis (two of seven patients) and obstructive jaundice (one of seven patients). Diagnosis was based on clinical findings, plain abdominal X‐rays, ultrasonography and computed tomography scanning. Surgery was the treatment of choice and cholecystectomy alone or in combination with common bile duct exploration and drainage (if needed) was performed.Conclusion:  The clinical aspect of the disease is similar to that of biliary lithiasis and the diagnosis is easily made by the characteristic spontaneous opacification of the gall bladder on plain abdominal X‐rays. Complications such as acute cholecystitis, pancreatitis or obstructive jaundice can also be present. Although some cases of conservative pharmaceutical treatment as well as cases of spontaneous disappearance of limy bile have been reported, surgical treatment remains the treatment of choice.
Contribution of investigations to the diagnosis of bilateral vas aplasia
Authors: Kumar Rajeev , Thulkar Sanjay , Kumar Virender , Jagannathan N. R. , Gupta Narmada P. 
Published: September 2005

Background:  Bilaterally absent vas deferens is a surgically uncorrectable cause of male infertility. It is usually diagnosed clinically. We evaluate the role of semen analysis and radiological imaging in providing objective evidence of vas aplasia.Methods:  Twenty consecutive patients with clinically suspected bilateral vas aplasia were enrolled for this prospective study. They were investigated on the basis of an algorithm till corroborative evidence for vas aplasia was obtained. This successively included a semen analysis on at least two occasions, transrectal ultrasonogram (TRUS), pelvic magnetic resonance imaging (MRI) and scrotal exploration. The contribution of each investigation to confirming the diagnosis was evaluated.Results:  Seventeen patients (85%) had a low volume ejaculate while all 20 had azoospermia and semen fructose levels below normal. Semen pH was non‐acidic in 75% of cases and thus was not contributory to the diagnosis. TRUS and MRI were non‐contributory in 30% and 50% of evaluations, respectively. The clinical diagnosis was found to be correct in all patients.Conclusions:  Vas aplasia is a clinical diagnosis. Low volume ejaculate with azoospermia and low or absent semen fructose is sufficient corroborative evidence and no further investigations are required for this diagnosis.
Incidental gall bladder carcinoma: does the surgical approach influence the outcome?
Authors: Cucinotta Eugenio , Lorenzini Cesare , Melita Giuseppinella , Iapichino Giuliano , Currò Giuseppe 
Published: September 2005

Background:  The aim of the study was to evaluate the outcome in patients with unsuspected gall bladder carcinoma diagnosed after cholecystectomy, comparing the laparoscopic approach with open surgery.Methods:  A retrospective study was done of 16 patients who were diagnosed with unsuspected gall bladder carcinoma out of the 2850 who had undergone cholecystectomy for symptomatic cholelithiasis at our institution between 1990 and 2004. Eight cases (seven women and one man, mean age 63 (range 49−75 years) ) were diagnosed after laparoscopic cholecystectomy (group A) and eight cases (six women and two men, mean age 63 (range 50−79 years) ) after open cholecystectomy (group B). We evaluated the outcome in the two groups correlating the cumulative survival rates with tumour stage and surgical technique.Results:  In group A, three patients had port‐site recurrence (1 pT1a and 2 pT1b tumours) after 6, 7 and 9 months, one had intraperitoneal dissemination (pT2) after 3 months, and four had no recurrence (1 pTis, 2 pT1a and 1 pT1b). In group B, five patients had recurrences (4 pT1b and 1 pT2) after an average of 8 months (range 5−11) and three had no recurrence (1 pTis and 2 pT1a). Survival rate was statistically correlated with tumour stage but not with the surgical approach used to perform cholecystectomy.Conclusions:  The surgical approach used for cholecystectomy would seem not to influence the outcome in patients with unsuspected gall bladder carcinoma. The tumour stage is the most important prognostic factor.
Rate of return to work and driving following arthroscopic subacromial decompression
Authors: McClelland Damian , Paxinos Anastasios , Dodenhoff Ronald M. 
Published: September 2005

Background:  The aim of the present paper was to evaluate the return to work and return to driving of a cohort of patients undergoing arthroscopic subacromial decompressions ± arthroscopic acromioclavicular joint excision.Methods:  Arthroscopic subacromial decompressions ± arthroscopic acromioclavicular joint excision were performed in 68 patients between February 2000 and November 2000. All patients had symptoms of subacromial impingement ± acromioclavicular joint arthrosis for more than 6 months that had not settled with conservative treatment. All had positive local anaesthetic injection tests. All patients were followed up at 3 weeks and 3 months postoperatively. Their Constant−Murley score was measured preoperatively and at 3 weeks and 3 months postoperatively. Patients were asked to record when they had returned to work and when they had returned to driving.Results:  Only one non‐manual worker did not return to work within 6 weeks. Eighty‐five per cent of manual workers returned to manual work within 3 months. Fifty‐one patients held driving licences. The average time to return to driving was 28.9 days. Average preoperative Constant−Murley scores were 47.5 (20−67). At 3 weeks postoperation average Constant−Murley scores were 66.8 (40−92), and at 3 months 76.5 (48−99).
Comparison of blue dye and isotope with blue dye alone in breast sentinel node biopsy
Authors: Syme David B. Y. , Collins John P. , Mann G. Bruce 
Published: September 2005

Background:  Sentinel lymph node biopsy (SNB) is rapidly gaining acceptance as an alternative to axillary dissection (AD) in patients with early breast cancer. Debate continues regarding the optimum technique for sentinel node (SN) mapping. We have used our series of 364 SNBs to compare two different techniques.Methods:  A retrospective review of patients undergoing SNB by surgeons in our breast service. Overall results were analysed, with particular attention to those having blue dye alone and those having blue dye in combination with radio‐labelled colloid. SNs were analysed using haematoxylin−eosin and immunohistochemical staining.Results:  SN identification rates were similar: 96% for dye alone and 89% for dye and colloid in combination. Twenty‐one per cent of SN mapped with dye alone contained metastases, compared to 30% with dye and colloid in combination. The false‐negative rate was correspondingly higher in the dye alone group (21 vs 2.8%).Conclusion:  SNB using dye and colloid in combination was significantly superior to dye alone in this series. We advocate using both dye and colloid for intraoperative SN mapping.