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Publisher: John Wiley and Sons   (Total: 1583 journals)

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Showing 1 - 200 of 1583 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 11, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 54, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 43, SJR: 0.547, h-index: 30)
ACEP NOW     Free  
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 50, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 135, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 5, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 54, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 7, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 35, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 5, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 2)
Addiction     Hybrid Journal   (Followers: 32, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 12, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 24, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 24, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 48, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 13, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 246, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 4, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 4)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 17, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 19)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 12)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 9)
African Development Review     Hybrid Journal   (Followers: 32, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 14, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 9, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 6, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 14, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 44, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 28, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 33, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 49, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 127, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 90, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 28, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 30, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 12, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 15, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 3, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 5, SJR: 2.315, h-index: 79)
American J. of Orthopsychiatry     Hybrid Journal   (Followers: 4, SJR: 0.756, h-index: 69)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 35, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 237, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 14, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 15, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 116, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 11, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 15)
Anatomia, Histologia, Embryologia: J. of Veterinary Medicine Series C     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 27)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1, SJR: 0.633, h-index: 24)
Andrologia     Hybrid Journal   (Followers: 2, SJR: 0.528, h-index: 45)
Andrology     Hybrid Journal   (Followers: 2, SJR: 0.979, h-index: 14)
Angewandte Chemie     Hybrid Journal   (Followers: 153)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 204, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 34, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 5, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 8, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 42, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 9, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 12)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 24, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 16, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 14)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 93, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 45, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 6, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 66, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 6, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 133, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 48, SJR: 0.868, h-index: 13)
Applied Stochastic Models in Business and Industry     Hybrid Journal   (Followers: 5, SJR: 0.613, h-index: 24)
Aquaculture Nutrition     Hybrid Journal   (Followers: 13, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 31, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 34, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 27, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 14, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 24, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 4)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 12, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 205, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 48, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 27, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 13)
Asia & the Pacific Policy Studies     Open Access   (Followers: 15)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 319, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 7, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 3, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 3, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 4, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 13, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 2, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 12, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 10, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 7, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 7, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 13, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 3, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 42, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 6, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 4, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 22, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 13, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 16, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 382, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 4, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 64, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 11, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 19, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 31, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 9, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 3, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 8, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 22, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 9, SJR: 0.11, h-index: 5)
Beton- und Stahlbetonbau     Hybrid Journal   (Followers: 2, SJR: 0.493, h-index: 14)
Biochemistry and Molecular Biology Education     Hybrid Journal   (Followers: 6, SJR: 0.311, h-index: 26)
Bioelectromagnetics     Hybrid Journal   (Followers: 1, SJR: 0.568, h-index: 64)
Bioengineering & Translational Medicine     Open Access  
BioEssays     Hybrid Journal   (Followers: 10, SJR: 3.104, h-index: 155)
Bioethics     Hybrid Journal   (Followers: 14, SJR: 0.686, h-index: 39)
Biofuels, Bioproducts and Biorefining     Hybrid Journal   (Followers: 1, SJR: 1.725, h-index: 56)
Biological J. of the Linnean Society     Hybrid Journal   (Followers: 14, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 2, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 44, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 37, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 45, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 135, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 13, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 17, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 10, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 33, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 5, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)

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Journal Cover Anz Journal of Surgery
  [SJR: 0.432]   [H-I: 59]   [6 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1445-1433 - ISSN (Online) 1445-2197
   Published by John Wiley and Sons Homepage  [1583 journals]
  • Effect of magnesium on arrhythmia incidence in patients undergoing
           coronary artery bypass grafting
    • Authors: Alireza Mohammadzadeh; Farshad Towfighi, Naser Jafari
      Abstract: BackgroundCardiac arrhythmia after coronary artery bypass grafting (CABG) surgery is a common complication of cardiac surgery. The effect of serum magnesium, hypomagnesaemia treatment and prophylactic administration of magnesium in the development and prevention of arrhythmias is controversial and there are many different ideas. This study evaluates the therapeutic effects of magnesium in cardiac arrhythmia after CABG surgery.MethodsThe clinical trial enrolled 250 patients who underwent CABG. Based on the initial serum levels of magnesium, patients were divided into two groups: hypomagnesium and normomagnesium. Based on bioethics committee requirements, patients in the hypo-magnesium group received magnesium treatments until they attained normal magnesium blood levels. Both groups underwent CABG with normal blood levels of magnesium. After surgery, each group was randomly divided into two subgroups: one subgroup received a bolus dose of magnesium sulphate (30 mg/kg in 5 min) and the other subgroup received a placebo. Subgroups were under observation in the intensive care unit for 3 days and arrhythmias were recorded. Data from all four subgroups were analysed statistically and interpreted.ResultsThe results of this study showed that the occurrence of arrhythmia was not significantly different among subgroups (P > 0.05). There was no significant relationship between blood levels of magnesium and arrhythmia during the 3 days post-surgery (P > 0.05).ConclusionThe results of this study showed that magnesium sulphate administration did not significantly improve the incidence of arrhythmias in hypo- and normo-magnesium patients after CABG. There was no significant correlation between post-operative serum levels of magnesium and arrhythmia during 3 days.
      PubDate: 2017-05-22T00:55:26.924966-05:
      DOI: 10.1111/ans.14056
  • Multidisciplinary management of metastatic melanoma to the inter-atrial
    • Authors: Andrei M. Beliaev; Peter N. Ruygrok, Rosalie Stephens, David A. Haydock
      PubDate: 2017-05-21T22:45:34.863373-05:
      DOI: 10.1111/ans.14057
  • Comparison of 5-year oncological outcomes of breast cancer based on
           surgery type
    • Authors: Jeeyeon Lee; Jin Hyang Jung, Wan Wook Kim, Yee Soo Chae, Soo Jung Lee, Ho Yong Park
      Abstract: BackgroundA standardized classification system for breast surgery that incorporates oncoplastic techniques is needed. We classified the surgical techniques for breast cancer treatment into five groups according to the extent of surgery and reconstructive methods, i.e. conventional breast-conserving surgery, partial mastectomy with volume displacement, partial mastectomy with volume replacement, simple mastectomy and total mastectomy with immediate reconstruction. We then evaluated the oncological outcomes for each of the five groups.MethodsWe analysed clinical data and 5-year oncological results from patients with breast cancer who underwent breast surgery with reconstruction between 2008 and 2013. Local recurrence, distant metastasis and overall survival were investigated.ResultsIn total, 1469 patients had 1504 breast surgeries performed with a mean follow-up of 72.40 ± 16.76 months. There were 35 cases (2.3%) of locoregional recurrence and 85 cases (5.7%) of distant metastasis, and the 5-year overall survival rate was 98.6%. No statistically significant differences were observed in local recurrence, distant metastasis or death among the five surgical technique groups (P = 0.218, 0.518 and 0.450, respectively).ConclusionOncological outcomes among all patients and within each surgical technique group were excellent during the 5-year follow-up period. No significant differences in oncological results were observed among the five surgical technique groups.
      PubDate: 2017-05-21T22:45:32.09464-05:0
      DOI: 10.1111/ans.14017
  • Medial sural artery perforator free flap for the reconstruction of leg,
           foot and ankle defect: an excellent option
    • Authors: Jyoshid R. Balan
      Abstract: BackgroundThe defects over the leg, foot and ankle are best covered with a thin pliable flap. The use of muscle flap for the reconstruction of these defects leaves a grafted, aesthetically inferior result. The medial sural artery perforator (MSAP) free flap gives a thin pliable tissue for the reconstruction with better aesthesis.MethodsThe study design was retrospective case analysis over a period of 2 years. All the patients who underwent flap for leg, foot and ankle defect reconstruction in the form of MSAP free flap were included in the study. The flap characteristics and aesthesis were assessed along with the patient satisfaction. The flap complication and donor site morbidity were also analysed.ResultsA total of seven MSAP free flaps were done for leg, foot and ankle reconstruction. The mean flap size was 14.29 × 6.6 cm and mean pedicle length was 9.71 cm. One flap had venous congestion post-operatively resulting in marginal flap loss. All the flaps had acceptable aesthesis with good patient satisfaction. There was donor site morbidity in two patients, in the form of wound dehiscence.ConclusionMSAP free flap is a reliable choice for leg, foot and ankle defect reconstruction.
      PubDate: 2017-05-16T19:56:42.669124-05:
      DOI: 10.1111/ans.14050
  • Predict pancreatic fistula after pancreaticoduodenectomy: ratio body
           thickness/main duct
    • Authors: Louise Barbier; Diane Mège, Anthony Reyre, Vincent M. Moutardier, Jacques A. Ewald, Jean-Robert Delpero
      Abstract: BackgroundThe occurrence of post-operative pancreatic fistula (POPF) after pancreaticoduodenectomy is a challenging issue. The aim was to identify variables on preoperative computed tomography (CT) scan, useful to predict clinically significant POPF (grades B–C) after pancreaticoduodenectomy.MethodsPatients presented POPF after pancreaticoduodenectomy were included from two tertiary referral centres. B/W ratio was defined by ratio of pancreas body thickness (B) to main pancreatic duct (W). The predictive parameters of POPF on CT scan were assessed with a receiving operator characteristics (ROC) curve and intrinsic characteristics.ResultsBetween 2010 and 2013, 186 patients who underwent pancreaticoduodenectomy were included. POPF occurred in 25% of them, and was clinically significant in 13%. After univariate analysis, endocrine tumours (P = 0.03), main pancreatic duct size (P 3.8 increased the rates of post-operative haemorrhage (odds ratio = 4.3 (1.4–13.2), P = 0.01), and reintervention (odds ratio = 3.4 (1.2–9.6), P = 0.02).ConclusionsB/W ratio superior to 3.8 assessed on preoperative CT scan may be an easy tool to predict clinically significant POPF after pancreaticoduodenectomy.
      PubDate: 2017-05-16T19:56:29.950201-05:
      DOI: 10.1111/ans.14048
  • Dermatofibrosarcoma protuberans of the scalp: therapeutic challenges
    • Authors: Davendran Kanesen; Zaitun Zakaria, Ewe S. Ch'ng, Puneet Nandrajog, Regunath Kandasamy
      PubDate: 2017-05-16T19:56:27.227606-05:
      DOI: 10.1111/ans.14040
  • Cholecystitis in situs inversus totalis
    • Authors: Nicolas J. Copertino; David Grieve
      PubDate: 2017-05-16T19:56:17.78255-05:0
      DOI: 10.1111/ans.14037
  • Extramedullary leukaemia presenting as cardiac myeloid sarcoma
    • Authors: Monica Peravali; Kartik R. Kumar, Jayadev R. Mettu, Nour Abd Almohsen, Anupama R. Kottam, Frank A. Baciewicz, Luis Afonso
      PubDate: 2017-05-16T19:56:12.44881-05:0
      DOI: 10.1111/ans.14036
  • The Australian laparoscopic radical prostatectomy learning curve
    • Authors: Marcus Handmer; Charles Chabert, Ronald Cohen, Troy Gianduzzo, Paul Kearns, Daniel Moon, Jason Ooi, Tom Shannon, David Sofield, Andrew Tan, Mark Louie-Johnsun
      Abstract: BackgroundInternational estimates of the laparoscopic radical prostatectomy (LRP) learning curve extend to as many as 1000 cases, but is unknown for Fellowship-trained Australian surgeons.MethodsProspectively collected data from nine Australian surgeons who performed 2943 consecutive LRP cases was retrospectively reviewed. Their combined initial 100 cases (F100, n = 900) were compared to their second 100 cases (S100, n = 782) with two of nine surgeons completing fewer than 200 cases.ResultsThe mean age (61.1 versus 61.1 years) and prostate specific antigen (7.4 versus 7.8 ng/mL) were similar between F100 and S100. D'Amico's high-, intermediate- and low-risk cases were 15, 59 and 26% for the F100 versus 20, 59 and 21% for the S100, respectively. Blood transfusions (2.4 versus 0.8%), mean blood loss (413 versus 378 mL), mean operating time (193 versus 163 min) and length of stay (2.7 versus 2.4 days) were all lower in the S100. Histopathology was organ confined (pT2) in 76% of F100 and 71% of S100. Positive surgical margin (PSM) rate was 18.4% in F100 versus 17.5% in the S100 (P = 0.62). F100 and S100 PSM rates by pathological stage were similar with pT2 PSM 12.2 versus 9.5% (P = 0.13), pT3a PSM 34.8 versus 40.5% (P = 0.29) and pT3b PSM 52.9 versus 36.4% (P = 0.14).ConclusionThere was no significant improvement in PSM rate between F100 and S100 cases. Perioperative outcomes were acceptable in F100 and further improved with experience in S100. Mentoring can minimize the LRP learning curve, and it remains a valid minimally invasive surgical treatment for prostate cancer in Australia even in early practice.
      PubDate: 2017-05-16T19:56:06.022534-05:
      DOI: 10.1111/ans.14025
  • Mucinous non-neoplastic cyst of the pancreas: is surgical resection
    • Authors: Shefali Agrawal; Munita Bal
      PubDate: 2017-05-16T19:56:04.925467-05:
      DOI: 10.1111/ans.14028
  • Aortocoronary artery dissection: a partial aortic root remodelling, aortic
           valve repair and coronary artery bypass
    • Authors: Andrei M. Beliaev; Jeevesh J. Thomas, Peter N. Ruygrok, Colleen Bergin, Sara J. Allen, Sophie E. Gormack, Jens Lund
      PubDate: 2017-05-16T19:55:56.845017-05:
      DOI: 10.1111/ans.14026
  • Modern cardiac surgery: the future of cardiac surgery in Australia
    • Authors: Nikki Stamp; Emily Granger, Robert Larbalestier
      Abstract: Cardiac surgery is a relatively young specialty and is undergoing many changes presently. The advent of catheter-based technology, minimally invasive surgery and better information regarding the roles of cardiac surgery in the management of common cardiac disease is changing the way we provide services. In Australia, attention must be turned to the way cardiac surgical services are provided to enable delivery of modern procedures. This has implications for the provision of training. We explore the face of modern cardiac surgery and how this may be taken up in Australia.
      PubDate: 2017-05-16T19:55:51.390261-05:
      DOI: 10.1111/ans.14031
  • Subspecialty approach for the management of acute cholecystitis: an
           alternative to acute surgical unit model of care
    • Authors: Sonia Tran; Vincent Choi, Kirsten Hepburn, Nathan Hewitt, Joel Zhou, Daniel L. Chan, Michael L. Talbot
      Abstract: BackgroundAcute cholecystitis is a common condition. Recent studies have shown an association between creation of an acute surgical unit (ASU) and improved outcomes. This study aimed to evaluate the outcomes of a subspecialty based approach to the management of acute cholecystitis as an alternative to the traditional ‘generalist’ general surgery approach or the ASU model.MethodA 6-year retrospective analysis of outcomes in patients admitted under a dedicated upper gastrointestinal service for acute cholecystitis undergoing emergency laparoscopic cholecystectomy.ResultsSeven hundred emergency laparoscopic cholecystectomies were performed over this time. A total of 486 patients were available for analysis. The median time to operation was 2 days and median length of operation was 80 min. A total of 86.9% were performed during daylight hours. Eight cases were converted to open surgery (1.6%). Intra-operative cholangiography was performed in 408 patients. The major complication rate was 8.2%, including retained common bile duct stones (2.3%), sepsis (0.2%), post-operative bleeding (0.4%), readmission (0.6%), bile leak (2.1%), AMI (0.4%), unscheduled return to theatre (0.6%) and pneumonia (0.8%). There were no mortalities and no common bile duct injuries.ConclusionOver a time period that encompasses the current publications on the ASU model, a subspecialty model of care has shown consistent results that exceed established benchmarks. Subspecialty management of complex elective pathologies has become the norm in general surgery and this study generates the hypothesis that subspecialty management of patients with complex emergency pathologies should be considered a valid alternative to ASU. Access block to emergency theatres delays treatment and prolongs hospital stay.
      PubDate: 2017-05-16T19:55:47.969598-05:
      DOI: 10.1111/ans.13986
  • Tail gut cyst: an unusual case
    • Authors: Devesh Kaushal; Raymond Yap, Daniel Moses, Mark Muhlmann
      PubDate: 2017-05-16T19:55:46.42294-05:0
      DOI: 10.1111/ans.14030
  • Patterns of head and neck sarcoma in Australia
    • Authors: Roger H. Woods; J. Alexa Potter, Jessica L. Reid, Jennie Louise, Taryn Bessen, Gelareh Farshid, Susan J. Neuhaus
      Abstract: BackgroundSarcomas affecting the head and neck often require complex management due to the combination of anatomic, aesthetic and oncological considerations. The incidence and patterns of presentation are poorly understood and have not been reviewed in the Australian population.MethodThis study sourced incidence and demographic data from the National Cancer Registry at the Australian Institute of Health and Welfare for the years 1982–2009 (corresponding to 97.3% of the Australian population). All cases of sarcoma, according to ICD-O-3 classification ((International Classification of Diseases for Oncology, 3rd edition), were assessed.ResultsA total of 3911 new cases of sarcoma affecting the head and neck were recorded during the period 1982–2009, including 1383, 2106 and 442 cases arising from skin, soft tissue and bone, respectively. The annual incidence rate of sarcomas affecting the head and neck was 1.59 per 100 000 population. The incidence of head and neck sarcoma rose substantially in older age groups (age 65 years and above) and was most common in male patients (69%). Malignant fibrous histiocytoma (MFH) was the most common pathology. There was an increase in incidence in skin-origin sarcoma in the head and neck, particularly affecting elderly males.ConclusionThe incidence of head and neck sarcoma in Australia is higher than that reported for an equivalent European population. The increase in MFH arising from the skin in elderly male patients mirrors the patterns of common cutaneous malignancy, particularly melanoma, suggesting that ultraviolet radiation is an epidemiological factor. Management of head and neck sarcoma is complex and best managed in a specialist multidisciplinary environment.
      PubDate: 2017-05-16T19:55:42.305732-05:
      DOI: 10.1111/ans.14018
  • Derivation and validation of the APPEND score: an acute appendicitis
           clinical prediction rule
    • Authors: Hinetamatea Mikaere; Irene Zeng, Melanie Lauti, Malsha Kularatna, Andrew D. MacCormick
      Abstract: BackgroundAlthough many clinical prediction rules (CPRs) for appendicitis exist, none have been developed for a New Zealand population presenting with right iliac fossa (RIF) pain. The aim of this study was to derive and validate an appendicitis CPR for our population.MethodThis is a retrospective review of all patients from December 2010 to February 2012 of at least 15 years of age presenting to the general surgery service with RIF pain. Patient data were divided into derivation and validation groups. Univariate and multiple regression analyses identified significant predictors of appendicitis which were used to construct a CPR. A retrospective validation study was then performed and the CPR was refined accordingly. Finally, the accuracy of the CPR was tested.ResultsThe final components of the new CPR, the APPEND score, were Anorexia, migratory Pain, local Peritonism, Elevated C-reactive protein, Neutrophilia and male gender (Dude). This CPR has an area under the receiver operating characteristic curve of 0.84. The CPR can stratify patients into low, intermediate and high-risk groups which may standardize patient care and reduce the negative appendicectomy rate.ConclusionA new CPR for predicting appendicitis, in patients presenting with RIF pain, has been derived and validated for use in our population. A prospective study to further evaluate its performance is required.
      PubDate: 2017-05-16T19:55:40.777737-05:
      DOI: 10.1111/ans.14022
  • Influence of primary site on metastatic distribution and survival in stage
           IV colorectal cancer
    • Authors: Arul E. Suthananthan; Mayank Bhandari, Cameron Platell
      Abstract: BackgroundTo assess pattern distribution and prognosis of the three anatomical entities of metastatic colorectal cancer, and influence of treatment of metastases on survival.MethodsPatients presenting with stage IV colorectal cancer (synchronous group), or who developed metastatic recurrence (metachronous group) after initial curative treatment between January 2005 and August 2015 were reviewed. Right sided (cecum to transverse colon), left sided (splenic flexure to sigmoid colon) and rectal cancers were identified. Distribution of metastases were noted as hepatic, lung or peritoneal.ResultsOf 374 patients, 276 were synchronous, 98 were metachronous. Metachronous group had a better 3-year survival (54%, 95% CI: 42–64 versus 33%, 95% CI: 27–39, log rank P = 0.0038). There were equal numbers of right (n = 119), left (n = 115) and rectal cancers (n = 140). Rectal cancers had a higher metastatic recurrence, yet demonstrated better 3-year survival (right colon 45%, 95% CI: 19–67, left colon 49%, 95% CI: 27–68, rectum 59%, 95% CI: 42–72, P = 0.39) due to higher proportions of metachronous patients undergoing treatment for metastases (40 versus 14%). Over half of all organ metastases spread to liver, with equal distribution from all three anatomical groups. Rectal cancers showed highest preponderance for lung metastases.ConclusionRectal cancers have a higher chance of recurring, with a higher metastatic rate to the lung, yet demonstrate better survival outcomes in metastatic colorectal cancer, reflecting the benefit of intervention for metastases.
      PubDate: 2017-05-16T19:55:32.674241-05:
      DOI: 10.1111/ans.13969
  • Left lobe of liver in a Morgagni's hernia
    • Authors: Antonio Navarro-Sánchez; José López-Fernández, Juan Ramón Hernández-Hernández
      PubDate: 2017-05-14T19:42:10.647207-05:
      DOI: 10.1111/ans.14023
  • The volume, cost and outcomes of pancreatic resection in a regional centre
           in New Zealand
    • Authors: Neil Wylie; Phillip Hider, Delwyn Armstrong, Sanket Srinivasa, Michael Rodgers, Anna Brown, Jonathan Koea
      Abstract: BackgroundThe frequency, costs and outcome of pancreatic resection (both pancreaticoduodenectomy and distal pancreatectomy) were reviewed in our own institution and correlated with regional population growth as well as national resection rates and locations.MethodsDemographic, pathological and outcome data on pancreaticoduodenectomy and distal pancreatectomy were obtained from a prospectively maintained database for the years 2005–2009 and 2010–2014. During this period, the catchment population grew from 460 000 to 567 000. Costing information was obtained from the hospital-independent costing and coding committee, and the locations and rates of pancreatic resection were obtained by interrogating the national minimum dataset.ResultsA total of 41 pancreatectomies (29 pancreaticoduodenectomy, 12 distal pancreatectomy) were performed between 2005 and 2009, increasing to 84 pancreatectomies (55 pancreaticoduodenectomies, 27 distal pancreatectomies and two total pancreatectomies) between 2010 and 2014. This constituted one sixth of the national volume of pancreatic resections. There was no difference in patient demographics or indications for resection between the two time periods; however, portal vein resection was used more frequently in the second period. Margin positivity rate decreased (7 of 41 versus 8 of 84) and lymph node harvest increased (median 8 nodes versus median 15 nodes) between the two time periods. Overall 30-day mortality was 1.6%.ConclusionIn New Zealand, regional rates of pancreatic resection reflect regional population demands, and institutional growth is driven by local population requirements. Institutional growth can be achieved with the maintenance of internationally accepted outcomes and quality indicators.
      PubDate: 2017-05-14T19:42:04.839504-05:
      DOI: 10.1111/ans.13984
  • Lymph node dissection for Siewert II esophagogastric junction
           adenocarcinoma: a retrospective study of 136 cases
    • Authors: Xiaofeng Duan; Xiaobin Shang, Peng Tang, Hongjing Jiang, Zhentao Yu
      Abstract: BackgroundTo compare the lymph node dissection with the right transthoracic Ivor-Lewis (IL) procedure to that with the left transthoracic (LT) approach for Siewert type II adenocarcinoma of the esophagogastric (AEG) junction.MethodsIn this study, 136 patients with Siewert type II AEG who met the inclusion criteria underwent surgical resection were divided into the IL (47 cases) and LT (89 cases) groups. The number and frequency of the dissected lymph nodes in each station were compared between the two groups.ResultsThe IL group had a longer proximal surgical margin (P = 0.000) and more total (P = 0.000), thoracic (P = 0.000), and abdominal lymph nodes (P = 0.000) dissected than the LT group. In general, the IL group had a higher dissection rate in each thoracic lymph node station (P 
      PubDate: 2017-05-14T19:41:59.923021-05:
      DOI: 10.1111/ans.13980
  • Clinical and radiological features of an unusual fungal infection of
    • Authors: Pritesh P. Kothari; Rajesh K. Ambulgekar, Vikram K. Kandhari, Deepak N. Bhatia
      PubDate: 2017-05-14T19:41:56.669399-05:
      DOI: 10.1111/ans.14024
  • Risk factors for pedicled flap necrosis in hand soft tissue
           reconstruction: a multivariate logistic regression analysis
    • Authors: Xu Gong; Jianli Cui, Ziping Jiang, Laijin Lu, Xiucun Li
      Abstract: BackgroundFew clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis.MethodsFor patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model.ResultsOf 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P 
      PubDate: 2017-05-08T07:31:07.863444-05:
      DOI: 10.1111/ans.13977
  • Scrotal extraperitoneal ureteroinguinal hernia with a horseshoe kidney
    • Authors: Michael C. Auld; Kylie Gallagher, Ahmad Ali
      PubDate: 2017-05-08T00:39:51.508985-05:
      DOI: 10.1111/ans.13983
  • Management of recurrent bleeding after pancreatoduodenectomy
    • Authors: Ralph F. Staerkle; Justin S. Gundara, Thomas J. Hugh, Richard Maher, Brendan Steinfort, Jaswinder S. Samra
      Abstract: BackgroundRe-bleeding after management of a first haemorrhage following pancreatic surgery is an ever-present danger and often presents diagnostic and management dilemmas.MethodsAll cases of post-pancreatectomy haemorrhage (PPH) following pancreatoduodenectomy were identified from a tertiary referral, clinical database (April 2004–April 2013). Only those suffering a second re-bleeding episode were included in the final case notes review.ResultsA total of 301 patients underwent pancreatoduodenectomy during the study period (most common indication: pancreatic adenocarcinoma; 49.5%). Twenty-two (7.3%) patients suffered a PPH (five early). Of these cases, three suffered a re-bleeding event (one mortality). Endoscopy, interventional radiology and surgery were employed in each case.ConclusionPPH presents major clinical challenges and is associated with significant morbidity and mortality. Early detection of the site and type of bleeding are critical and multimodal therapy is usually required. Interventional radiology techniques are making a major contribution to overall management.
      PubDate: 2017-05-08T00:39:35.168112-05:
      DOI: 10.1111/ans.13976
  • Management of a large cystic lymphangioma causing intestinal obstruction
    • Authors: Michael J. O'Grady; Josephine O'Grady
      PubDate: 2017-05-05T22:09:24.144944-05:
      DOI: 10.1111/ans.13965
  • Australian validation of the Cancer of the Prostate Risk Assessment
           Post-Surgical score to predict biochemical recurrence after radical
    • Authors: Kerri Beckmann; Michael O'Callaghan, Andrew Vincent, David Roder, Jeremy Millar, Sue Evans, John McNeil, Kim Moretti
      Abstract: BackgroundThe Cancer of the Prostate Risk Assessment Post-Surgical (CAPRA-S) score is a simple post-operative risk assessment tool predicting disease recurrence after radical prostatectomy, which is easily calculated using available clinical data. To be widely useful, risk tools require multiple external validations. We aimed to validate the CAPRA-S score in an Australian multi-institutional population, including private and public settings and reflecting community practice.MethodsThe study population were all men on the South Australian Prostate Cancer Clinical Outcomes Collaborative Database with localized prostate cancer diagnosed during 1998–2013, who underwent radical prostatectomy without adjuvant therapy (n = 1664). Predictive performance was assessed via Kaplan–Meier and Cox proportional regression analyses, Harrell's Concordance index, calibration plots and decision curve analysis.ResultsBiochemical recurrence occurred in 342 (21%) cases. Five-year recurrence-free probabilities for CAPRA-S scores indicating low (0–2), intermediate (3–5) and high risk were 95, 79 and 46%, respectively. The hazard ratio for CAPRA-S score increments was 1.56 (95% confidence interval 1.49–1.64). The Concordance index for 5-year recurrence-free survival was 0.77. The calibration plot showed good correlation between predicted and observed recurrence-free survival across scores. Limitations include the retrospective nature and small numbers with higher CAPRA-S scores.ConclusionsThe CAPRA-S score is an accurate predictor of recurrence after radical prostatectomy in our cohort, supporting its utility in the Australian setting. This simple tool can assist in post-surgical selection of patients who would benefit from adjuvant therapy while avoiding morbidity among those less likely to benefit.
      PubDate: 2017-05-04T04:46:45.053166-05:
      DOI: 10.1111/ans.13954
  • The ties that bind: what's in a title'
    • Authors: Susan J. Neuhaus
      Abstract: BackgroundMany Australian and New Zealand surgeons use the title ‘Mister’ rather than ‘Doctor’, a practice dating back to traditions established over 600 years ago. The Royal Australasian College of Surgeons is currently undergoing a period of critical self-reflection, embodied by its ‘Respect’ campaign. Active measures to embrace diversity and encourage women into surgery are underway.MethodsThis paper reviews the historical basis to the use of gendered titles and their current use amongst fellows. De-identified demographic data from the college register of active fellows was searched by self-identified title, country or state, and gender. Data were further reviewed by surgical sub-specialty and year of fellowship.ResultsThe college dataset suggests that there is significant variance in the preference for gendered titles, determined predominantly by geography rather than specialty. The highest use of gendered titles (by male and female surgeons) was in Victoria/Tasmania (58% male, 22% female) and New Zealand (81% male, 17% female). By contrast, only 2% of female surgeons in other states elected a gendered title (Miss/Mrs/Ms).ConclusionSurgery is the only profession that continues to use gendered titles. As the College of Surgeons moves towards greater equity and diversity, consideration should be given to phasing out the use of gendered titles, which serve to divide rather than unite our profession.
      PubDate: 2017-05-04T04:46:23.248205-05:
      DOI: 10.1111/ans.13961
  • Chronic peritoneal inflammation and nodules masquerading as peritoneal
           carcinomatosis in Birt–Hogg–Dube syndrome
    • Authors: Jonathan Kam; Yuigi Yuminaga, Mark Louie-Johnsun
      PubDate: 2017-05-03T17:55:49.800276-05:
      DOI: 10.1111/ans.13967
  • Delayed haemothorax and fracture of titanium plate rib fixation following
           oncologic chest wall reconstruction
    • Authors: Mansher Singh; Edward M. Kobraei, Kristo Nuutila, Jon O. Wee, Edward J. Caterson
      PubDate: 2017-05-03T17:55:41.289544-05:
      DOI: 10.1111/ans.13963
  • Early experience with totally laparoscopic major hepatectomies: single
           institution experience with 31 consecutive cases
    • Authors: Brian K. P. Goh; Chung Yip Chan, Ser Yee Lee, Alexander Y. F. Chung
      Abstract: BackgroundTotally laparoscopic major hepatectomy (LMH) is a technically challenging procedure with limited studies mainly from high-volume expert centers reported. In this study, we report our initial experience with totally LMH.MethodsA retrospective review of a prospective database of 340 consecutive patients who underwent laparoscopic liver resection at a single institution was conducted. Thirty-one consecutive patients who underwent attempted totally LMH between March 2011 to December 2016 were identified. Major hepatectomies were defined as resection of ≥3 contiguous segments which included only right/left hepatectomies, extended hepatectomies or central hepatectomies.ResultsThe procedures included 11 right hepatectomies, one extended right hepatectomy, nine left hepatectomies (two including middle hepatic vein), two extended left hepatectomies, two left hepatectomies with caudate lobe and six central hepatectomies. The median tumor size was 40 (range, 12–100) mm and the median operation time was 435 (range, 245–585) min. Median blood loss was 500 (range, 100–1900) mls and 10 (32.3%) patients required blood transfusion. There were three (9.7%) open conversions of which two occurred during the first five cases. There was one (3.2%) major (>grade 2) morbidity and there were no 30-day/in-hospital mortalities or reoperations. The median postoperative stay was 5 (range, 3–14) days.ConclusionOur initial experience confirms the feasibility and safety of LMH. There was an increase in the number and proportion of LMH performed at our institution over time.
      PubDate: 2017-05-03T17:55:35.855578-05:
      DOI: 10.1111/ans.13959
  • Incidental large retroperitoneal teratoma in a patient with colorectal
    • Authors: Vignesh Narasimhan; Marty Smith, Matthew Claydon, Roger Wale, Satish Warrier
      PubDate: 2017-05-02T10:48:59.483815-05:
      DOI: 10.1111/ans.13906
  • Ischaemic bowel due to migrated intra-uterine contraceptive device: a
           rare, delayed complication of intra-uterine contraceptive devices
    • Authors: Sara Mellow; Hwa Ian Ong, Marilyn Wong, Mohamed Atalla
      PubDate: 2017-05-02T10:48:55.630149-05:
      DOI: 10.1111/ans.13910
  • Impact of avoiding post-operative urinary catheters on outcomes following
           colorectal resection in an ERAS programme: no IDUC and ERAS programmes
    • Authors: Samuel T. Roberts; Kiraati Patel, Stephen R. Smith
      Abstract: BackgroundThe presence of an indwelling urinary catheter (IDUC) is routine following colorectal resections. In Enhanced Recovery After Surgery programmes, excessive intravenous fluids (IVFs) are avoided. This study sought to determine whether the routine absence of an IDUC following colorectal surgery improved post-operative outcomes and minimized fluid prescription.MethodsA retrospective comparative cohort study was performed on patients undergoing colorectal resection at a tertiary referral teaching hospital, over a 7-year period. A policy of no routine IDUC was introduced over the last 3 years. Patients were divided into cohorts based on the presence or absence of an IDUC on leaving the operating theatre. The outcomes assessed were IVF prescription, length of stay, mortality and morbidity.ResultsOf the 213 resections over the time period, 131 met the inclusion criteria (87 IDUC and 44 no IDUC). There was no difference between groups with respect to baseline demographics. Fluid administration was less in the group without routine IDUC (total fluid 6.16 L versus 10.89 L; P 
      PubDate: 2017-05-02T10:48:51.554128-05:
      DOI: 10.1111/ans.13916
  • Has the autonomy pendulum swung too far'
    • Authors: Paul Walker
      Abstract: BackgroundThis paper aims to contribute to the discussion about patient-centred care in surgery. It is contended here that the paradigm shift towards patient-centred decision-making in health care does not mean that patient values alone (or those of their proxies) should, uncritically, be the lead decision makers in determining surgical care.MethodsIn support of that contention, three clarifications to our conception of autonomy will be offered.ResultsFirst, autonomy may not be best positioned as the lead principle guiding healthcare decision-making. Second, arguably, our traditional understanding of autonomy, as it might be applied to health care, is incomplete. Third, where autonomy is vested is contentious, and proxy decision makers can further complicate the decision-making process.ConclusionIt will be argued that an approach of inclusive, non-coercive and reflective dialogue seeking a consensual decision amongst all those affected is more appropriate for moral decision-making in surgery. This dialogue is set in the actual reality of the patient's illness. During the discourse, each participant has equal rights to contribute and to be heard, equal duties not to coerce and equal co-responsibilities to share the perspectives of others in the discourse, with an aim to reach consensus.
      PubDate: 2017-04-25T23:16:29.778774-05:
      DOI: 10.1111/ans.14053
  • Association of waist circumference with outcomes in an acute general
           surgical unit
    • Authors: Thomas Ryan; Preet Gosal, Alexa Seal, Joe McGirr, Nicholas Williams
      Abstract: BackgroundObesity prevalence is increasing in Australia, particularly in non-metropolitan areas. The effect of obesity on acute surgical outcomes is not known. We aimed to record waist circumference (WC) (surrogate for obesity) amongst acute surgical unit (ASU) patients in a New South Wales regional hospital, and compare outcome measures (length of stay (LOS), unplanned return to theatre, readmission rates, intensive care unit (ICU) admission and mortality).MethodsRetrospective cohort study of 4 months of consecutive ASU admissions, excluding age
      PubDate: 2017-04-24T04:35:01.404064-05:
      DOI: 10.1111/ans.13962
  • Pursuing the second ipsilateral gland during minimally invasive
           video-assisted parathyroidectomy
    • Authors: Cino Bendinelli; Andrew Gray, Hassan Suradi, Dieter G. Weber, Shamasunder Acharya, Anna Price, Shaun McGrath
      Abstract: BackgroundIn patients with primary hyperparathyroidism (PHPT) and preoperative imaging suggesting a solitary parathyroid adenoma (SPA), focused parathyroidectomy is most often curative. Even so, large studies show up to 3% of patients experience persistent or recurrent PHPT. Unilateral neck exploration (UNE) aiming to identify the SPA and the other ipsilateral parathyroid may reduce this failure rate. We hypothesized that: (i) minimally invasive video-assisted (MIVA) approach would facilitate UNE and (ii) this would be a clinically relevant strategy.MethodsProspective case series of a consecutive cohort of PHPT patients (with preoperative diagnosis of SPA), who underwent MIVA-UNE. A 15 mm collar incision and endoscopic magnification were utilized to both excise the SPA and seek the ipsilateral parathyroid gland.ResultsFrom 2009 to 2014, 132 patients were offered MIVA-UNE (age: 63.0 (interquartile range: 11.2); females: 94 (71.2%); symptomatic: 89 (67.4%); mean serum corrected calcium: 2.7 (standard deviation: 0.9) mmol/L; mean serum parathyroid hormone: 16.8 (standard deviation: 11.8) pmol/L). Conversion from MIVA-UNE to open UNE was required in 14 (10.6%) patients (excluded from subsequent analysis). MIVA-UNE was concluded in 118 patients. The second ipsilateral parathyroid was identified in 62 (52.5%) patients and in 13 (11.0%) it appeared enlarged and was excised. Histopathology confirmed five (4.2%) of these glands to be hyperplastic.ConclusionMIVA-UNE allows identification of the second ipsilateral parathyroid in about half the patients. This approach helped to diagnose and treat unexpected multigland disease in almost 5% of patients.
      PubDate: 2017-04-21T04:05:46.559395-05:
      DOI: 10.1111/ans.13956
  • Ewing sarcoma of the sternal manubrium: first report of a case in
           Australasia and review of the literature
    • Authors: Danus Ravindran; Yassar Alamri, Samantha Gerrie, Andrew Brainard
      PubDate: 2017-04-16T15:51:00.097616-05:
      DOI: 10.1111/ans.13957
  • Gastrointestinal mucormycosis in an immunocompromised host
    • Authors: Michael Kwok; Andrew Maurice, James Carroll, Jason Brown, Carl Lisec, Leo Francis, Bhavik Patel
      PubDate: 2017-04-16T15:50:58.184195-05:
      DOI: 10.1111/ans.13955
  • Cystic mesenteric lymphangioma: a case report
    • Authors: Pramod Durgakeri; Beth Penington
      PubDate: 2017-04-16T15:50:48.980504-05:
      DOI: 10.1111/ans.13950
  • Pneumatosis intestinalis related to jejunal feeding
    • Authors: Rebecca Ling; David Ren, Hamish Shilton, Dean Spilias
      PubDate: 2017-04-16T15:50:45.67499-05:0
      DOI: 10.1111/ans.13952
  • Associating Liver Partition and Portal vein ligation for Staged
           hepatectomy after pre-operative chemotherapy
    • Authors: Florian W. R. Vondran; Felix Oldhafer, Kristina I. Ringe, Thomas C. Wirth, Moritz Kleine, Mark D. Jäger, Juergen Klempnauer, Hueseyin Bektas
      Abstract: BackgroundRecently a procedure termed ‘Associating Liver Partition and Portal vein ligation for Staged hepatectomy’ (ALPPS) was developed to increase the resectability of marginally resectable or locally unresectable liver tumours. This study focused on the application of ALPPS in patients with advanced colorectal liver metastases (CRLM) and pre-operative chemotherapy, with the aim to investigate whether the latter still allows for sufficient hypertrophy of the future liver remnant (FLR) following the first step of ALPPS.MethodsRetrospective analysis was performed on six patients suffering from advanced CRLM. Analyses comprised demographical and basic clinical data, the perioperative courses as well as short- and long-term outcomes.ResultsAll patients presented with bilobular CRLM and pre-operative chemotherapy of at least 6 months. Extended right hemihepatectomy was performed in all cases, four patients additionally received atypical resections in segments II/III. Mean FLR prior to step 1 of ALPPS was 397.9 cm3 (121–753 cm3), on average representing 20.9% of the total liver volume (13.2–27.1%). A mean hypertrophy of the FLR of 67.9% (32.5–94.1%) was achieved. Overall, severe morbidity (Dindo Clavien >3a) occurred in two patients. Following completion of ALPPS, mean post-operative disease-free survival was 5.7 months (2.6–8.9 months).ConclusionDespite pre-operative chemotherapy, ALPPS seems to result in adequate liver hypertrophy, preventing post-operative small-for-size syndrome. However, there might be a high risk of tumour recurrence in patients with an aggressive tumour biology.
      PubDate: 2017-04-16T15:50:43.168378-05:
      DOI: 10.1111/ans.13944
  • Total thyroidectomy for pressure symptoms in patients with Hashimoto's
    • Authors: Katrina Heggie; Meei Yeung, Simon Grodski, James Lee, Jonathan Serpell
      Abstract: BackgroundHashimoto's thyroiditis (HT) is rarely on its own the indication for thyroidectomy. However, surgery in patients with HT will be undertaken when there is malignancy and may be required for pressure symptoms. Therefore, this study aimed to investigate the indications for surgery in HT patients.MethodsThe Monash University Endocrine Surgery Database was analysed from 1994 to 2013 for patients with HT. Patients with HT were compared to a similar group of patients with no HT on histopathology. Patient demographics, indication for surgery, histopathology, gland weight and complications were analysed.ResultsA total of 2346 patients underwent total thyroidectomy during the study period. The median age was 55 years. Eleven percent of patients had HT on final pathology (259/2346). HT patients reported more pressure symptoms, 25.5% compared to those with other pathology, 18.9% (P = 0.01). Patients with pressure symptoms had heavier glands, 113 g compared to 85 g in those with other indications for surgery (P = 0.048). Within the HT cohort, the median gland weight was 66 g compared to 93 g in those without HT (P 
      PubDate: 2017-04-16T15:50:41.63683-05:0
      DOI: 10.1111/ans.13943
  • Extended pancreatic head resection for pancreatic cancer in the presence
           of a circumportal pancreas
    • Authors: Birte Kulemann; Jens Hoeppner
      PubDate: 2017-03-30T19:50:41.309607-05:
      DOI: 10.1111/ans.14015
  • Comparison of cost of care for tethered versus non-tethered ureteric
           stents in the management of uncomplicated upper urinary tract stones
    • Authors: Alfin Okullo; Yuigi Yuminaga, William Ziaziaris, David Ende, Howard Lau, Andrew Brooks, Manish I. Patel, Simon Bariol
      Abstract: BackgroundMany surgeons use a stent after ureteroscopic lithotripsy (URSL). For short-term stenting purposes, a surgeon has the choice of either a tethered or a non-tethered stent. Stents may be associated with complications that entail an additional cost to their use. There is a paucity of data on the direct healthcare cost of using stent type after either primary or secondary URSL.MethodsWe retrospectively reviewed medical records for patients who underwent URSL for uncomplicated urolithiasis between January 2013 and December 2013 at two tertiary referral hospitals. Costs data was sourced from the costing department with complete data available for 134 patients. The overall medical care cost was estimated by computing the cost of surgery, stent-related emergency department presentations, re-admissions and stent removal.ResultsA total of 113 patients had tethered stents and 21 had non-tethered stents, with similar age and gender composition between the two groups and complications rates. The mean cost of URSL and stent placement was A$3071.7 ± A$906.8 versus A$3423.8 ± A$808.4 (P = 0.049), mean cost of managing complications was A$309.4 ± A$1744.8 versus A$31.3 ± A$98.9 (P = 0.096), mean cost of out-patient clinic stent removal was A$222.5 ± A$60 versus A$1013.6 ± A$75.4 (P 
      PubDate: 2017-03-30T19:50:33.41967-05:0
      DOI: 10.1111/ans.13945
  • Cohort study on emergency general surgery patients and an observation unit
    • Authors: Marilla Dickfos; Hany Ibrahim, Andrew Evans, Robert Franz
      Abstract: BackgroundMedium-sized, non-trauma hospitals experience many of the same difficulties as tertiary centres do when it comes to managing emergency general surgery patients. However, acute surgical units are not a financially viable option in these hospitals. To improve the care of emergency general surgery patients at one such hospital, a Rapid Assessment Medical Surgical (RAMS) unit was developed to decrease the time to review and increase the efficiency in caring for these patients.MethodsTo assess the unit's effect, a prospective analysis was completed of the patients who came through the RAMS unit over a 6-month period and compared with a retrospective analysis of patients presenting in the same 6-month period the year prior to the unit's instigation.ResultsThe RAMS unit was effective in providing an avenue for faster review by the surgical team. This resulted in patients leaving the emergency department faster, decreased the number of patients that breached emergency department time-targets and increased the number of patients discharged after a period of observation or basic treatments.ConclusionGeneral surgery patients were managed more efficiently with the RAMS unit in place. However, a full cost analysis is required to determine if such units are cost-effective.
      PubDate: 2017-03-30T19:50:30.82812-05:0
      DOI: 10.1111/ans.13960
  • Common femoral artery disease in antiphospholipid syndrome: histopathology
    • Authors: Sukey Pan; Jill O'Donnell, Lubomyr D. Lemech, Fernando Roncolato, Fiona Bonar
      PubDate: 2017-03-26T22:45:36.374651-05:
      DOI: 10.1111/ans.13793
  • Rare finding of a fourth branchial cleft anomaly
    • Authors: Vignesh Narasimhan; Simon Grodski
      PubDate: 2017-03-24T00:01:12.646666-05:
      DOI: 10.1111/ans.13947
  • Acute cholangitis: current concepts
    • Authors: David Lan Cheong Wah; Christopher Christophi, Vijayaragavan Muralidharan
      Abstract: BackgroundAcute cholangitis, also known as ascending cholangitis, is a life-threatening systemic condition that results from a biliary tree infection and obstruction. Severe acute cholangitis was reported to have a mortality rate between 11 and 27% in the 1990s. This article is a literature review about acute cholangitis. Its aim is to review the latest literature about acute cholangitis and to discuss its pathogenesis, clinical presentation, diagnosis, prognosis, risk factors and treatment.MethodsOvid Medline and PubMed database searches were performed for articles about acute cholangitis published in English from 1877 to 2016. The keyword search headings included ‘acute’, ‘ascending’ and ‘cholangitis’, and a combination of these were used. Only articles with full-text descriptions were chosen for this literature review.ResultsCommon causes of biliary tree obstruction include choledocholithiasis, benign and malignant biliary strictures. According to the Tokyo Guidelines, clinical presentation, laboratory blood results and diagnostic imaging are important in the diagnosis of acute cholangitis. Treatments consist of intravenous fluids and antibiotics followed by biliary decompression and drainage. Available drainage options include endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, endoscopic ultrasound and open surgical drainage.ConclusionIt is important to diagnose acute cholangitis as early as possible to initiate appropriate treatments to reduce mortality and morbidity.
      PubDate: 2017-03-24T00:00:55.517599-05:
      DOI: 10.1111/ans.13981
  • Necrotising myofasciitis as the initial presentation of a vesico-urethral
           anastomotic leak after radical prostatectomy
    • Authors: Alfin Okullo; Samuel Rajadurai, Ashish Taneja, Benjamin Norris, Tania Hossack, Jeremy Hsu
      PubDate: 2017-03-22T22:00:44.70373-05:0
      DOI: 10.1111/ans.13971
  • Management of colorectal trauma: a review
    • Authors: Ju Yong Cheong; Anil Keshava
      Abstract: Traumatic colorectal injuries are common during times of military conflict, and major improvements in their care have arisen in such periods. Since World War II, many classification systems for colorectal trauma have been proposed, including (i) Flint Grading System; (ii) Penetrating Abdominal Trauma Index; (iii) Colonic/Rectal Injury Scale; and (iv) destructive/non-destructive colonic injuries. The primary goal of these classifications was to aid surgical management and, more particularly, to determine whether a primary repair or faecal diversion should be performed. Primary repair is now the preferred surgical option. Patients who have been identified as having destructive injuries have been found to have higher anastomotic leak rates after a primary repair. Damage control principles need to be adhered to in surgical decision-making. In this review, we discuss the mechanisms of injury, classifications, clinical presentation and current recommendations for the management of colorectal trauma.
      PubDate: 2017-03-20T18:19:29.598458-05:
      DOI: 10.1111/ans.13908
  • Appendiceal schwannoma: an incidental finding after Crohn's bowel
    • Authors: Melanie D. Crispin
      PubDate: 2017-03-20T18:19:28.346556-05:
      DOI: 10.1111/ans.13966
  • Tale of two cancers: don't forget the synchronous colon cancer!
    • Authors: Ju Yong Cheong; Raymond Oliphant, Anil Keshava
      PubDate: 2017-03-20T18:19:24.617996-05:
      DOI: 10.1111/ans.13970
  • Paediatric vertebral artery aneurysms: a literature review
    • Authors: Kevin Phan; Konrad Schultz, Victor M. Lu, Ryan J. Campbell, Nelson Wang, Prashanth J. Rao
      Abstract: Vertebral artery (VA) aneurysms in the paediatric population are a rare but a serious condition. However, the epidemiology of paediatric VA aneurysms is poorly understood and there is little consensus on what constitutes the appropriate treatment. Although multiple treatment options are available, including surgery, endovascular approaches, coil embolization and parent artery occlusion, there is limited clinical evidence regarding which approach is most optimal. This review outlines the current literature and evidence outlining the epidemiology, presentation, pathogenesis and treatment of paediatric VA aneurysms.
      PubDate: 2017-03-20T18:19:19.308638-05:
      DOI: 10.1111/ans.13940
  • Soft tissue infections from fish spike wounds: normal commensal bacteria
           are more common than marine pathogens
    • Authors: Hannah Collins; Kin Mun Lee, Paul T.-Y. Cheng, Sarah Hulme
      Abstract: BackgroundA fish spike injury can be sustained by anyone handling fish; during fishing, meal preparation or in retail. Case reports of fish spikes inoculating victims with virulent marine-specific pathogens and causing systemic illness led us to question whether empirical treatment of these injuries with amoxicillin and clavulanic acid is adequate.MethodsThis 2-year prospective observational study was conducted at Middlemore Hospital, Auckland, New Zealand. Wound swabs and tissue samples belonging to patients presenting to the Department of Plastic and Reconstructive Surgery with an upper limb fish spike injury were sent to the laboratory (n = 60). A series of stains and cultures were performed to look specifically for marine bacteria not typically isolated in other soft tissue injuries. Patient demographic data and injury details were collected.ResultsOf the patients with adequate microbiology samples, 12% (6/50) grew clinically relevant bacteria resistant to amoxicillin and clavulanic acid. These included methicillin-resistant Staphylococcus aureus (8%, 4/50), Enterobacter cloacae (2%, 1/50) and an anaerobic sporing bacillus (2%, 1/50). Only one patient grew a true marine-specific bacteria, Photobacterium damselae, which was susceptible to amoxicillin and clavulanic acid.ConclusionThe authors concluded that amoxicillin and clavulanic acid is an adequate first-line antibiotic for fish spike injuries but that flucloxacillin may be more appropriate given most bacteria were from patients’ own skin flora. The authors suggest that clinicians consider the presence of resistant marine-specific bacteria in cases where there is sepsis or inadequate response to initial therapy.
      PubDate: 2017-03-20T18:19:17.948726-05:
      DOI: 10.1111/ans.13850
  • Perforating and deep lymphatic vessels in the knee region: an anatomical
           study and clinical implications
    • Authors: Wei-Ren Pan; Fan-Qiang Zeng, De-Guang Wang, Zhi-Qiang Qiu
      Abstract: BackgroundTo determine the relationship between the perforating and deep lymphatic vessels in the knee region for clinical implications.MethodsFour lower limbs from two unembalmed human cadavers were used. Under a surgical microscope, 6% hydrogen peroxide was employed to detect lymph vessels accompanying the small saphenous vein, anterior tibial, posterior tibial and fibular blood vessels all commencing from distal ends of specimens. Each lymphatic vessel was inserted by a 30-gauge needle and injected with a barium sulphate mixture. Each specimen was dissected, radiographed and photographed to determine the perforating and deep lymphatic vessels in the region.ResultsA perforating lymph vessel was observed in the popliteal fossa of each specimen. It arose from the superficial popliteal lymph node and terminated in the deep popliteal lymph node. The anterior tibial, posterior tibial and peroneal lymph vessels were discovered in the region travelling with the corresponding vascular bundles. After penetrating the vascular aperture of the interosseous membrane between the tibia and fibula, the anterior tibial lymph vessel entered directly into the deep popliteal lymph node or converged to either the posterior tibial or fibular lymph vessel, before entering the node. The posterior tibial and peroneal lymph vessels entered the deep popliteal lymph node. The efferent lymph vessel of the deep popliteal lymph node travelled with the femoral vascular bundle.ConclusionThe perforating and deep lymphatic vessels in the knee region has been presented and discussed. The information advances our anatomical knowledge and the results will benefit clinical management.
      PubDate: 2017-03-20T05:01:19.314353-05:
      DOI: 10.1111/ans.13893
  • Histopathological tumour viability after neoadjuvant chemotherapy
           influences survival in resected pancreatic cancer: analysis of early
           outcome data
    • Authors: Phil Townend; Phil R. Reuver, Terence C. Chua, Anubhav Mittal, Stephen J. Clark, Nick Pavlakis, Anthony J. Gill, Jaswinder S. Samra
      Abstract: BackgroundNeoadjuvant therapy is increasingly recognized as an effective strategy prior to pancreatoduodenectomy. We investigate the role of neoadjuvant chemotherapy (NAC) followed by surgery and the predictive role of viable residual tumour cells histopathologically on outcomes.MethodsThe study population comprised of 195 consecutive patients with pancreatic adenocarcinoma who were treated with either NAC or a surgery-first (SF) strategy. Histopathological viable tumour cells were examined in the NAC patients and clinicopathological factors were correlated with overall survival.ResultsForty-two patients (22%) were treated with NAC and 153 patients (78%) underwent SF. NAC was associated with higher estimated blood loss during surgery (928 mL versus 615 mL; P = 0.004), fewer (65% residual tumour cells was 45% and 90% in patients who had
      PubDate: 2017-03-20T05:01:01.869846-05:
      DOI: 10.1111/ans.13897
  • Caecal bascule: a case series and literature review
    • Authors: Jin-Soo Park; Kheng-Seong Ng, Christopher J. Young
      Abstract: BackgroundCaecal bascule is a rare condition characterized by the inferior pole of the caecum folding on a horizontal axis antero-superiorly towards the ascending colon, potentially causing obstruction. An unusual variant of volvulus, diagnosis is challenging due to its obscurity. We present the experience of an Australian tertiary-referral hospital with the diagnosis/management of caecal bascule, and review cases reported in the literature to raise awareness of this uncommon diagnosis.MethodsMedical records of patients diagnosed with caecal bascule during 2001–2016 were reviewed. Data relating to their presentation, investigations, management and outcomes were obtained. A literature search was conducted through PubMed and Medline databases.ResultsCaecal bascule was diagnosed in four patients (median age: 60.5 (range: 48–75) years, two females). Patients presented with abdominal pain (4/4), distension (3/4), vomiting (3/4) and confusion (1/4) over a 1- to 4-day period. Computed tomography identified caecal displacement in three cases, and bascule was diagnosed at laparotomy in all cases. All patients underwent right hemicolectomy, with primary ileo-colic anastomosis in three cases and formation of Abcarian stoma in one case. Median length of stay was 15.5 days (range: 10–24), with no mortality. Fifteen cases of caecal bascule have been reported in the literature to date, with authors suggesting resection as definitive treatment.ConclusionCorrect diagnosis of caecal bascule requires a high index of suspicion and avoids delay of appropriate management. Recent operation, particularly laparoscopic cholecystectomy, may be contributing factors. Resection is recommended, a sentiment echoed by reported cases in the literature.
      PubDate: 2017-03-20T05:00:44.113488-05:
      DOI: 10.1111/ans.13898
  • Blue nevus-like and blue nevus-associated melanoma: a comprehensive review
           of the literature
    • Authors: Thore L. Borgenvik; Tina M. Karlsvik, Saikat Ray, Monica Fawzy, Nick James
      Abstract: BackgroundMalignant blue nevus, blue nevus-associated melanoma and blue nevus-like melanoma are all terms used to describe malignant melanomas arising from, in association with, or resembling blue nevi. This review is aimed at summarizing the available literature to reduce the confusion surrounding this rare malignancy, and aid the surgeon in choosing further diagnostic or therapeutic measures.MethodsWe conducted a search of Medline, Embase, Science Direct, Scopus and the Cochrane Library for all full text articles published in English that reported on a malignant melanoma arising from, in association with, or resembling a blue nevus.ResultsWe identified 91 cases that fit the criteria above. The mean age at diagnosis was 45 years, with a slight male predominance (males: 48; females: 43). Metastatic cases were reported in 55% (n = 50), of which 16 were metastatic at the time of diagnosis, 16 developed metastases within the first year and 18 within 5 years of initial diagnosis. The mean Breslow thickness was 6.8 mm at the time of diagnosis (n = 39).ConclusionsThe histological criteria for diagnosing this malignancy are very poorly defined, and may contribute to the substantial confusion surrounding the terminology. There is no consensus on which prognostic indicators predictive of outcome in ‘conventional’ malignant melanoma are applicable to blue nevus-like melanoma/blue nevus-associated melanoma. However, two larger case series have demonstrated a significant association between Breslow thickness (or largest tumour dimension when non-epidermal) and recurrence-free survival, as well as rate of local recurrence, but larger studies are needed to confirm this.
      PubDate: 2017-03-20T05:00:40.53977-05:0
      DOI: 10.1111/ans.13946
  • Trends in the surgical treatment of benign prostatic hyperplasia in a
           tertiary hospital
    • Authors: Darren Ow; Nathan Papa, Marlon Perera, Peter Liodakis, Shomik Sengupta, Stephen Clarke, Damien M. Bolton, Nathan Lawrentschuk
      Abstract: BackgroundTo assess current treatment trends and perioperative outcomes of transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) in a tertiary institution.MethodsWe prospectively collected a database of all patients undergoing TURP and PVP for benign prostatic hyperplasia (BPH) at a tertiary hospital between January 2011 and December 2013. Patient characteristics such as length of stay, readmission, anticoagulation status, American Society of Anesthesiologists (ASA) score and need for blood transfusion were recorded and analysed.ResultsIn total, 560 cases were included: 204 (36.4%) underwent TURP and 356 (63.6%) PVP. Patients undergoing PVP had higher ASA scores (P 
      PubDate: 2017-03-19T20:25:54.823551-05:
      DOI: 10.1111/ans.13904
  • Diagnostic accuracy of computed tomography-guided biopsy in pathological
    • Authors: Christopher M. Stokes; Osama Elsewaisy, Grant Pang, John L. Slavin, Stephen M. Schlicht, Peter F. M. Choong
      Abstract: BackgroundObtaining a histological diagnosis is essential for appropriate management of pathological fractures. Computed tomography (CT) is an accurate method of obtaining diagnosis for musculoskeletal tumours. We analysed whether diagnostic accuracy was maintained in the evaluation of pathological fractures.MethodsA retrospective review of 101 consecutive patients presenting to our tertiary musculoskeletal tumour centre with pathological fracture was performed. Patients underwent core needle biopsy under CT guidance of pathological fractures diagnosed by plain radiography and either CT or magnetic resonance imaging. The histopathology of the CT-guided biopsy was compared with the sample obtained from open biopsy or definitive surgery to determine diagnostic accuracy.ResultsThe mean age at diagnosis was 52 ± 20 years (range: 18–85) in a cohort of 46 men and 55 women. Diagnostic accuracy of CT-guided biopsy was 82.18%. There were 65 malignant and 36 benign tumours with diagnostic accuracy of 86.15% and 80.56%, respectively. The positive predictive value for a malignant tumour was 98.21% whilst it was 93.1% for benign tumours. The femur (53 cases) and humerus (25 cases) were the commonest bones fractured. The most frequent diagnoses were metastasis (20.79%), giant cell tumour (17.82%), osteosarcoma (9.90%) and myeloma (9.90%). There were no complications of CT-guided biopsy.ConclusionPathological fracture does not confound the diagnosis of musculoskeletal tumours. CT-guided biopsy is an accurate diagnostic tool in the evaluation of pathological fractures. Final diagnosis and management should be made in the context of appropriate anatomical and functional imaging using a multidisciplinary approach.
      PubDate: 2017-03-17T06:40:48.055353-05:
      DOI: 10.1111/ans.13894
  • Causes of pain and loss of function in rotator cuff disease: analysis of
           1383 cases
    • Authors: Anthony Maher; Warren Leigh, Matt Brick, Simon Young, Michael Caughey
      Abstract: BackgroundThe New Zealand Rotator Cuff Registry is a multicentre, nationwide prospective study of rotator cuff repairs established in March 2009.MethodsA total of 1383 rotator cuff repairs were included in this study, all with completed baseline Flex-SF scores, pain scores and standardized operative forms.ResultsIncreasing tear size and tear retraction, over 4 cm, were associated with decreasing Flex-SF scores but not pain. Tear area (a composite of tear size and retraction) is increased with advancing age, male gender and a traumatic history but not with smoking. Increased pain scores were associated with supraspinatus (SS) single tears, compared to subscapularis tears, and with labral tears. SS/infraspinatus tears had lower Flex-SF scores compared to subscapularis/SS.ConclusionThis study presents the relationship between baseline function, pain and tear characteristics in symptomatic rotator cuff tears. Increasing tear size and retraction are related to a loss of function but have minimal effect upon pain. Pain generators included labral pathology, and the involvement of SS. The intraoperative appearance of the long head of biceps pathology did not predict baseline pain and function.
      PubDate: 2017-03-17T06:21:09.674199-05:
      DOI: 10.1111/ans.13870
  • Incidental parathyroidectomy during total thyroidectomy is not a direct
           cause of post-operative hypocalcaemia
    • Authors: Carolyn Chew; Ran Li, Michael K. Ng, Steven T. F. Chan, Bill Fleming
      Abstract: BackgroundPost-operative hypocalcaemia is the most common complication after total thyroidectomy, with a reported incidence of transient hypocalcaemia up to 50% and permanent hypocalcaemia 1.5–4%. The impact of incidental parathyroidectomy (IPE) on post-operative hypocalcaemia remains controversial. This study evaluated the risk factors for IPE following total thyroidectomy and compared post-operative calcium levels serially between patients with and without IPE.MethodsA retrospective analysis of patients undergoing total thyroidectomy from January 2009 to October 2016 at Western Health was conducted. Histopathology reports were reviewed to identify specimens that included parathyroid tissue. Risk factors and dichotomous data were analysed by exact test of difference in binomial proportions. Group comparison of serial calcium levels (preoperative to 48 h post-operative) between the no IPE and IPE patients were analysed by calculating the area under the curve producing a time series summary.ResultsFour hundred and sixty-eight patients were included: 395 were females (81%), with a median age of 51 years. IPE was confirmed histologically in 84 patients (17.7%) and was more likely to occur in patients undergoing total thyroidectomy with central neck dissection (P = 0.0003), and in patients with malignant disease (P = 0.0005). The difference in area under the curve for serial post-operative calcium levels between the no IPE and the IPE groups was 0.61 (P = 0.21, 95% confidence interval: −0.37 to 1.58).ConclusionTotal thyroidectomy for malignancy and with central node dissection had a higher risk of IPE but did not result in significant changes in post-operative serum calcium levels.
      PubDate: 2017-03-17T06:20:58.012714-05:
      DOI: 10.1111/ans.13939
  • An unusual complication of extra nodal Hodgkin's lymphoma
    • Authors: Joshua S. Lawson; Sanjay Singh
      PubDate: 2017-03-17T04:53:19.210547-05:
      DOI: 10.1111/ans.13867
  • Making best use of the journal online
    • Authors: John P. Harris
      Pages: 323 - 323
      PubDate: 2017-05-03T17:58:40.830667-05:
      DOI: 10.1111/ans.13973
  • Laparoscopic appendicectomy in pregnancy: is it safe'
    • Authors: Philip G. Truskett
      Pages: 324 - 324
      PubDate: 2017-05-03T17:58:42.119448-05:
      DOI: 10.1111/ans.13936
  • Shoulder to knee: lessons learnt
    • Authors: Peter F. M. Choong
      Pages: 325 - 325
      PubDate: 2017-05-03T17:58:39.792463-05:
      DOI: 10.1111/ans.13968
  • Optical diagnosis of diminutive colorectal polyps
    • Authors: Shinichiro Sakata; Sanjeev Naidu, Andrew R. L. Stevenson, David G. Hewett
      Pages: 326 - 327
      PubDate: 2017-05-03T17:58:39.228296-05:
      DOI: 10.1111/ans.13531
  • Management of colonic polyps: an advancing discipline
    • Authors: Amir Klein; Michael J. Bourke
      Pages: 327 - 330
      PubDate: 2017-05-03T17:58:39.331528-05:
      DOI: 10.1111/ans.13612
  • Medicine in small doses
    • Authors: Bruce P. Waxman
      Pages: 331 - 331
      PubDate: 2017-05-03T17:58:41.958129-05:
      DOI: 10.1111/ans.13974
  • 25, 50 & 75 years ago
    • Authors: John P. Harris
      Pages: 332 - 333
      PubDate: 2017-05-03T17:58:38.8704-05:00
      DOI: 10.1111/ans.13964
  • Re: Laparoscopic or open appendicectomy for suspected appendicitis in
           pregnancy and evaluation of foetal outcome in Australia
    • Authors: Hai T. Bui; Steven T. F. Chan
      Pages: 420 - 420
      PubDate: 2017-05-03T17:58:40.736523-05:
      DOI: 10.1111/ans.13864
  • Re: Bacteriological study in perianal abscess is not useful and not
    • Authors: Carly N. Bisset; Lachlan Dick, Ye Ru Chin, Louise Summers, Andrew Renwick
      Pages: 420 - 421
      PubDate: 2017-05-03T17:58:39.856183-05:
      DOI: 10.1111/ans.13878
  • Anorectal melanoma: a rare aggressive type of melanoma
    • Authors: Edoardo Virgilio; Paolo Mercantini, Giusi Santangelo, Giulia Canali, Valentina Peritore, Genoveffa Balducci
      Pages: 421 - 422
      PubDate: 2017-05-03T17:58:42.042226-05:
      DOI: 10.1111/ans.13942
  • Response to Re: Bacteriological study in perianal abscess is not useful
           and not cost-effective
    • Authors: Roland Xu; Ker-Kan Tan, Choon-Seng Chong
      Pages: 421 - 421
      PubDate: 2017-05-03T17:58:38.050777-05:
      DOI: 10.1111/ans.13972
  • Re: The Australasian contribution to the development of neurosurgery in
    • Authors: A. W. Beasley
      Pages: 422 - 422
      PubDate: 2017-05-03T17:58:40.917733-05:
      DOI: 10.1111/ans.13948
  • Laparoscopic or open appendicectomy for suspected appendicitis in
           pregnancy and evaluation of foetal outcome in Australia
    • Authors: Nicole N. Winter; Glenn D. Guest, Michael Bozin, Benjamin N. Thomson, G. Bruce Mann, Stephanie B. M. Tan, David A. Clark, Jurstine Daruwalla, Vijayaragavan Muralidharan, Neeha Najan, Meron E. Pitcher, Karina Vilhelm, Michael R. Cox, Steven E. Lane, David A. Watters
      Pages: 334 - 338
      Abstract: BackgroundRecent data suggest that laparoscopic appendicectomy (LA) in pregnancy is associated with higher rates of foetal loss when compared to open appendicectomy (OA). However, the influence of gestational age and maternal age, both recognized risk factors for foetal loss, was not assessed.MethodThis was a multicentre retrospective review of all pregnant patients who underwent appendicectomy for suspected appendicitis from 2000 to 2012 across seven hospitals in Australia. Perioperative data and foetal outcome were evaluated.ResultsData on 218 patients from the seven hospitals were included in the analysis. A total of 125 underwent LA and 93 OA. There were seven (5.6%) foetal losses in the LA group, six of which occurred in the first trimester, and none in the OA group. After matching using propensity scores, the estimated risk difference was 5.1% (95% confidence interval (CI): 1.4%, 9.8%). First trimester patients were more likely to undergo LA (84%), while those in the third were more likely to undergo OA (85%). Preterm delivery rates (6.8% LA versus 8.6% OA; CI: −12.6%, 5.3%) and hospital length of stay (3.7 days LA versus 4.5 days OA; CI: −1.3, 0.2 days) were similar.ConclusionThis is the largest published dataset investigating the outcome after LA versus OA while adjusting for gestational and maternal age. OA appears to be a safer approach for pregnant patients with suspected appendicitis.
      PubDate: 2016-09-06T18:35:30.457981-05:
      DOI: 10.1111/ans.13750
  • Management of malignant colorectal polyps in New Zealand
    • Authors: Jesse Fischer; Bruce Dobbs, Liane Dixon, Tim W. Eglinton, Christopher J. Wakeman, Frank A. Frizelle,
      Pages: 350 - 355
      Abstract: BackgroundThe management of colorectal polyps containing a focus of malignancy is problematic, and the risks of under- and over-treatment must be balanced. The primary aim of this study was to describe the management and outcomes of patients with malignant polyps in the New Zealand population; the secondary aim was to investigate prognostic factors.MethodsRetrospective review of relevant clinical records at five New Zealand District Health Boards.ResultsOut of the 414 patients identified, 51 patients were excluded because of the presence of other relevant colorectal pathology, leaving 363 patients for analysis. Of these, 182 had a polypectomy, and 181 had a bowel resection as definitive treatment. The overall 5-year survival was not altered with resection but was improved with re-excision of any form (repeat polypectomy or bowel resection). There were 110 rectal lesions and 253 colonic lesions. A total of 16% of patients who had resection after polypectomy were found to have residual cancer in the resected specimen. Ischaemic heart disease, chronic obstructive pulmonary disease and metastatic disease were found to negatively impact overall survival (P < 0.001). Resection was more likely to follow polypectomy if polypectomy margins were positive, fragmentation occurred for sessile lesions and for pedunculated lesions with a higher Haggitt level.ConclusionPolypectomy is oncologically safe in selected patients. Re-excision improves overall survival and should be considered in patients with low comorbidity (American Society of Anesthesiologists score 1 and 2) and where there is concern about margins (sessile lesions and positive polypectomy margins). In the majority of patients, however, no residual disease is found.
      PubDate: 2016-04-08T01:31:29.853391-05:
      DOI: 10.1111/ans.13502
  • Clinical outcomes and safety of distal biceps repair using a modified
           entry point
    • Authors: Mohammed Baba; Johanna Viktoria Leon, Michael Symes, Oscar Dorrestijn, Allan Young, Benjamin Cass
      Pages: 376 - 379
      Abstract: BackgroundThe purpose of this study is to determine the safety of a one-incision technique for distal biceps repair with modified repair entry point in regards to the distance from the posterior interosseous nerve (PIN). Secondly, we present the clinical results of patients having undergone this procedure.MethodsTen cadaveric specimens were dissected to reveal the radial tuberosity. Two 1.6-mm guidewires were inserted into the radial tuberosity, one centrally, and one 5-mm more proximal. Both guidewires penetrated the dorsal cortex, and posterior dissection revealed their exit points. The distance from the PIN and each wire was determined using a vernier calliper. The functional outcomes of 10 patients’ post repair were reviewed. Performance was determined using strength and range of motion (ROM) measurements. Functional impairment was assessed using the disability of the arm, shoulder and hand outcome measure (DASH score). The uninjured side was used as a control.ResultsThe mean distance from the centre of the radial tuberosity to the PIN was 7.33 mm with a centrally placed wire, compared with 10.92 mm when measuring from the proximal guidewire (P < 0.05). Supination and flexion strengths were 83 and 90% of the uninjured side, respectively. There was a mean of 1.5° loss of flexion and 0° loss of extension. Loss of pronation and supination ROM were 0.5° and 4.5° on average, respectively. Average DASH score was 6.3.ConclusionWe recommend a 5-mm more proximal entry point for insertion of the guidewire during distal biceps repair. This poses less risk to the PIN without significant functional impairment. Our outcomes are comparable with those reported in the literature.
      PubDate: 2016-08-03T20:21:42.205417-05:
      DOI: 10.1111/ans.13684
  • Review of knee arthroscopic practice and coding at a major metropolitan
    • Authors: James P. Lisik; Michelle M. Dowsey, Joshua Petterwood, Peter F. M. Choong
      Pages: 380 - 384
      Abstract: BackgroundArthroscopic knee surgery has been a topic of significant controversy in recent orthopaedic literature. Multiple studies have used administrative (Victorian Admitted Episodes Dataset and Centre for Health Record Linkage) data to identify trends in practice. This study explored the usage and reporting of arthroscopic knee surgery by conducting a detailed audit at a major Victorian public hospital.MethodsA database of orthopaedic procedures at St Vincent's Hospital Melbourne was used to retrospectively identify cases of knee arthroscopy from 1 December 2011 to 1 April 2014. Procedures were categorized as diagnostic or interventional, and native and prosthetic joints were analysed separately. Procedure codes were reviewed by comparing a registrar, auditor and hospital coders for agreement.ResultsOf the 401 cases for analysis, 375 were conducted in native knees and 26 in prosthetic joints. Of native knees, 369 (98.4%) were considered interventional. The majority of these were conducted for meniscal pathology (n = 263, 70.1%), osteoarthritis (OA) (n = 25, 6.7%) and infection (n = 28, 7.6%). Comparison of codes assigned by different parties were found to be between 57% (k = 0.324) and 70% (k = 0.572) agreement, but not statistically significant.ConclusionsIn this study, the most common indication for arthroscopy was meniscal pathology. Arthroscopy was rarely performed for OA in the absence of meniscal pathology. Diagnostic arthroscopy was rarely performed in the native knee, and fair to moderate agreement existed between parties in assigning Medicare Benefits Schedule procedure codes.
      PubDate: 2016-09-27T19:46:10.809004-05:
      DOI: 10.1111/ans.13664
  • Early Australian experience in robotic sleeve gastrectomy: a single site
    • Authors: Candice D. Silverman; Michael A. Ghusn
      Pages: 385 - 389
      Abstract: BackgroundThe use of robotic platforms in bariatric surgery has recently gained relevance. With an increased use of this technology come concerns regarding learning curve effects during the initial implementation phase. The sleeve gastrectomy though may represent an ideal training procedure for introducing the robot into bariatric surgical practice. The present review of the first 10 consecutive robotic sleeve gastrectomy procedures performed in an Australian bariatric programme by a single surgeon describes the evolution of the technique, learning curve and initial patient outcomes.MethodsBetween 2014 and 2015, robotic sleeve gastrectomies were performed as primary and revisional procedures by a consistent surgeon–assistant team. Technique evolution and theatre set-up were documented. Patient demographics, operative time (robot docking and total operation time), additional operative procedures performed, operative and post-operative complications at 1, 3 and 6 months post-procedure and weight loss achieved at 6 months were retrospectively reviewed from a prospectively maintained database.ResultsTen robotic sleeve gastrectomies were performed without significant operative complications. One patient was treated as an outpatient with oral antibiotics for a superficial wound infection. The median total operative time was 123 min (interquartile range (IQR) 108.8–142.5), with a median incision to docking time of 19 min (IQR 15.0–31.8). Length of stay in hospital was 2–3 days. Median excess weight loss achieved at 6 months was 50% (IQR 33.9–66.5).ConclusionThis study describes a method of safely introducing the da Vinci robot into bariatric surgical practice.
      PubDate: 2016-04-15T04:02:45.212564-05:
      DOI: 10.1111/ans.13545
  • Long-term survival following open repair of ruptured abdominal aortic
    • Authors: Raymond Englund; Nedal Katib
      Pages: 390 - 393
      Abstract: BackgroundLong-term results for patients being managed for ruptured compared to elective abdominal aortic aneurysms (AAA) are unclear. We hypothesize that patients who survive 30 days or more following repair of ruptured AAA (RAAA) performed by open technique have a life expectancy no different to those patients surviving 30 days or more following elective AAA repair, or compared to a general age-matched population.MethodsBetween 1987 and December 2014, 620 consecutive patients were treated by the principal author for aortic aneurysmal disease. Two subgroups were selected from this population, elective open abdominal repair (215) and RAAA open repair (105). Comparable age-matched life curves with the general population were used from the Australian Bureau of Statistics for each patient according to gender, age and date of presentation. Statistical comparison was by Kaplan–Meier survival analysis.ResultsBoth the open and RAAA groups were well matched for age and sex. There was no statistical difference between RAAA survival and an age-matched population P = 0.23, or was there any difference between open repair and an age-matched population, P = 0.1. Survival curves for RAAA and open repair were similar, P = 0.98. For elective open repair 1-, 5-, 10-, 15- and 20-year survival was 93.6, 71.2, 40, 17 and 2% respectively. Corresponding results for RAAA were 92.5, 74, 36.7, 13.5 and 5% respectively.ConclusionOpen AAA repair for RAAA or elective aneurysm treatment restores predicted life expectancy for those patients surviving 30 days or more and is therefore a durable method of treatment for this condition.
      PubDate: 2016-08-12T04:45:35.260952-05:
      DOI: 10.1111/ans.13704
  • Abdominal aortic aneurysm repair in New Zealand: a validation of the
           Australasian Vascular Audit
    • Authors: Manar Khashram; Ian A. Thomson, Gregory T. Jones, Justin A. Roake
      Pages: 394 - 398
      Abstract: BackgroundIn New Zealand (NZ), there are two major sources of operative data for abdominal aortic aneurysm (AAA) repair: the Australasian Vascular Audit (AVA) and the National Minimum Data Set (NMDS). Since the introduction of the AVA in NZ, there has not been any attempt at the validation of outcome data. The aims of this study were to report the outcomes of AAA repair and validate the AAA data captured by AVA using the NMDS.MethodsAAA procedures performed in NZ from January 2010 to December 2014 were extracted from the AVA and NMDS. Patients identified from the AVA had their survival status matched to the NMDS. Only primary AAA procedures were included for the analysis, with re-interventions and graft infections excluded. Demographical, risk factors and outcome data were used for validation.ResultsThe number of patients undergoing primary AAA procedure from AVA and NMDS was 1713 and 2078, respectively. The AVA inpatient mortality for elective and rupture AAA was 1.6 and 32.2%, respectively. The NMDS 30-day mortality from AAA was 2.5 and 31.5%. Overall, 1604 patients were available for matching, and the NMDS correctly reported 98.1% of endovascular aneurysm repair and 94.2% of elective AAA repairs; however, there were major differences in comorbidity reporting between the data sets.ConclusionBoth data sets were incomplete, but combining administrative (NMDS) and clinical (AVA) data sets provided a more accurate assessment of mortality figures. More than 80% of AAA repairs are captured by AVA, but further work to improve compliance and comorbidity documentation is required.
      PubDate: 2016-08-04T23:11:18.040758-05:
      DOI: 10.1111/ans.13702
  • Anatomical study of prefixed versus postfixed brachial plexuses in adult
           human cadaver
    • Authors: Edengenet Guday; Asegedech Bekele, Abebe Muche
      Pages: 399 - 403
      Abstract: BackgroundThe brachial plexus is usually formed by the fusion of anterior primary rami of the fifth to eighth cervical and the first thoracic spinal nerves. Variations in the formation of the brachial plexus may occur. Variations in brachial plexus anatomy are important to radiologists, surgeons and anaesthesiologists performing surgical procedures in the neck, axilla and upper limb regions. These variations may lead to deviation from the expected dermatome distribution as well as differences in the motor innervation of muscles of the upper limb. This study is aimed to describe the anatomical variations of brachial plexus in its formation among 20 Ethiopian cadavers.MethodsObservational based study was conducted by using 20 cadavers obtained from the Department of Human Anatomy at University of Gondar, Bahir Dar, Addis Ababa, Hawasa, Hayat Medical College and St Paul Hospital Millennium Medical College. Data analysis was conducted using thematic approaches.ResultsA total of 20 cadavers examined bilaterally for the formation of brachial plexus. Of the 40 sides, 30 sides (75%) were found normal, seven sides (17.5%) prefixed, three sides (7.5%) postfixed and one side of the cadaver lacks cord formation.ConclusionThe brachial plexus formation in most subjects is found to be normal. Among the variants, the numbers of the prefixed brachial plexuses are greater than the postfixed brachial plexuses.
      PubDate: 2016-04-12T20:12:50.866963-05:
      DOI: 10.1111/ans.13534
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