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Publisher: John Wiley and Sons   (Total: 1580 journals)

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Showing 1 - 200 of 1580 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 13, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 65, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 47, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 52, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 158, 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: 6, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, 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: 6, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 4)
Addiction     Hybrid Journal   (Followers: 35, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 13, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 27, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 51, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 14, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 268, 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: 7, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
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: 21)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 13)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 10)
African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 15, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 11, 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: 16, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 31, 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: 51, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 145, 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: 33, 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: 16, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 6, SJR: 2.315, h-index: 79)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 37, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 272, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 15, 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: 17, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 136, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 10, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 18)
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: 196)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 219, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 39, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, 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: 7, 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: 47, 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: 13)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 25, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 17, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 15)
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: 90, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 49, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 7, 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: 70, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 206, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 49, 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: 14, 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: 36, 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: 15, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 25, 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: 5)
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: 246, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 50, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 26, 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: 15)
Asia & the Pacific Policy Studies     Open Access   (Followers: 16)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 323, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (Followers: 1, SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 8, 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: 4, 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: 4, 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: 6, 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: 12, 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: 15, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 9, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 6, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 14, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 4, 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: 47, 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: 7, 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: 29, 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: 14, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 18, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 408, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 5, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 72, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 12, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 20, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 36, 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: 11, 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: 5, 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: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 24, 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: 16, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 4, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 42, 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: 36, 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: 160, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 14, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 20, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 38, 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: 6, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)
BJOG : An Intl. J. of Obstetrics and Gynaecology     Partially Free   (Followers: 243, SJR: 2.083, h-index: 125)

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Journal Cover Anz Journal of Surgery
  [SJR: 0.432]   [H-I: 59]   [7 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  [1580 journals]
  • Intravenous fluid therapy in acute pancreatitis: a critical review of the
           randomized trials
    • Authors: Andrew Thomson
      Abstract: IntroductionFluid management is a cornerstone of treatment in acute pancreatitis (AP).MethodsIdentification of existing randomized prospective trials of patients with AP, in which intravenous fluid management was a significant parameter in the experimental design, was undertaken using the PubMed and ENDOBASE databases.ResultsIncluded patients in the seven studies identified were on the whole very unwell with deaths occurring in six trials. Fluid regimens in AP included crystalloid alone, combinations of crystalloid and colloid and in two studies, plasma. In most studies, patients with premorbid major organ failure and advanced age were excluded. Study entry within 6 h of presentation occurred in three trials. Initial fluid administration rates varied from 1 to 2 mL/kg/h to 15 mL/kg/h. Rapid fluid rates were associated with increased morbidity and mortality except in one study in which a high fluid regimen (20 mL/kg bolus within 4 h of presentation followed by 3 mL/kg) led to a better clinical outcome than a more conservative regimen. Use of Ringer's lactate led to improved surrogate outcome markers compared to that of normal saline in one study. Administration of colloid as part of the fluid management was associated with lower morbidity and lower fluid requirements.ConclusionRapid infusion of crystalloid very early in the course of AP may be beneficial but rapid infusion of fluid later in the course of the illness may be deleterious. Colloid administration and the use of Ringer's lactate solution in preference to normal saline may improve outcome.
      PubDate: 2017-11-22T04:18:25.106347-05:
      DOI: 10.1111/ans.14320
       
  • Nonsteroidal anti-inflammatory drugs and anastomotic dehiscence after
           colorectal surgery: a meta-analysis
    • Authors: Yeqian Huang; Stephen R. Tang, Christopher J. Young
      Abstract: BackgroundEnhanced recovery after surgery protocols supports the post-operative use of nonsteroidal anti-inflammatory drugs (NSAIDs) to minimize the use of opioids. However, there is an increasing concern on the impaired wound healing of anastomosis associated with NSAID use, potentially causing a higher risk of anastomotic leakage. The aim was to conduct a meta-analysis to evaluate the association of NSAIDs with anastomotic leakage after colorectal surgery.MethodsA literature search was conducted using the MEDLINE, PubMed, Cochrane Library and Clinicaltrial.gov. Studies identified were appraised with standard selection criteria. Data points were extracted and meta-analysis was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsSeventeen studies comprising of 26 098 patients were examined. The analysis of all studies showed a significantly lower rate of anastomotic dehiscence in the no-NSAID group (pooled odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.48–2.71, P 
      PubDate: 2017-11-22T04:18:15.847582-05:
      DOI: 10.1111/ans.14322
       
  • Comparison of three fixation methods in treatment of tibial fracture in
           adolescents
    • Authors: Lixiang Lin; Yang Liu, Chuanlu Lin, Yifei Zhou, Yongzeng Feng, Xiaolong Shui, Kehe Yu, Xiaolang Lu, Jianjun Hong, Yang Yu
      Abstract: BackgroundTibial fractures are the most common musculoskeletal injury in adolescents. The optimal management of tibial fractures in adolescents is controversial. In this study, we compared the outcomes including complications of three fixation methods in tibial fractures of adolescents and explored the factors associated with the complications.MethodsA retrospective cohort study about 83 diaphyseal tibial fractures in 79 children and adolescents, who were treated with plate fixation (PF), elastic stable intramedullary nail fixation (ESINF), or external fixation (EF), was conducted. After adjustment for age, weight, energy of the injury, polytrauma, fracture level and pattern, and extent of comminution, treatment outcomes were compared in accordance with the length of the hospital stay, time to union, and complication rates including many factors.ResultsThe mean age of the patients was 13.4 years, and their mean weight was 44.2 kg. There was a loss of reduction in two of 33 fractures treated with ESINF and four of 13 treated with EF (P 
      PubDate: 2017-11-21T03:12:23.35981-05:0
      DOI: 10.1111/ans.14258
       
  • Systematic review of disparities in surgical care for Māori in New
           Zealand
    • Authors: Jamie-Lee Rahiri; Zanazir Alexander, Matire Harwood, Jonathan Koea, Andrew G. Hill
      Abstract: BackgroundHealth equity for Indigenous peoples in the context of surgery has recently become topical amongst surgeons in Australasia. Health inequities are amongst the most consistent and compelling disparities between Māori and New Zealand Europeans (NZE) in New Zealand (NZ). We aimed to investigate where ethnic disparities in surgical care may occur and highlight some of the potential contributing factors, over all surgical specialties, between Māori and NZE adults in NZ.MethodsA systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A series of electronic searches were performed in Medline, Embase, PubMed and CINAHL.ResultsTen studies met the inclusion criteria. All studies employed a range of indicators for surgical care including receipt of surgery following diagnosis, delays to treatment and post-operative morbidity and mortality. Disparities in the receipt of surgical treatment for several cancers were observed for Māori and remained after adjustment for socioeconomic variables and extent of disease. Māori were more likely to experience delays in treatment and referral to other medical specialties involved in their care.ConclusionDespite the significant variation in the types of diseases, procedures and indicators of surgical care of the included studies, consistent findings are that disparities in different aspects of surgical care exist between Māori and NZE in NZ. This review highlights the need to better quantify the important issue of health equity for Māori in surgery given the lack of studies over the majority of surgical specialties.
      PubDate: 2017-11-18T00:05:54.204465-05:
      DOI: 10.1111/ans.14310
       
  • Suspended animation: the past, present and future of major cardiothoracic
           trauma
    • Authors: Syed Mohiyaddin; Prakash Nanjaiah, Ahmed O. Saad, Metesh N. Acharya, Tanveer A. Khan, Rhodri H. Davies, Saeed Ashraf
      Abstract: About 50% of the trauma victims die at the scene mostly because of exsanguinating haemorrhage. Most trials of resuscitation fail in face of the ongoing bleeding. Ongoing research/studies to save these victims by inducing rapid hypothermia using cardiopulmonary bypass as an emergency initial measure along with delayed resuscitation show improved outcomes. A comprehensive review of this research and analysis of studies showed that rapid induction of hypothermia within 5 min of cardiac arrest is associated with better survival and improved neurological outcome. This led us to conclude that suspended animation is a lifesaving modality for the treatment of trauma victims, otherwise hurtling towards certain death. This should be integrated into regular clinical practice. The US Food and Drug Administration has given its approval for clinical trials on such an intervention.
      PubDate: 2017-11-18T00:05:49.308002-05:
      DOI: 10.1111/ans.14313
       
  • Supraclavicular flap repair in the free flap era
    • Authors: Jodie Trautman; Sinclair Gore, Matthew Potter, Jonathan Clark, Dylan Hyam, Ngian C. Tan, Quan Ngo, Bruce Ashford
      Abstract: BackgroundSupraclavicular flap (SCF) repair is widely reported in head and neck surgery in select patients and defects. The authors’ objective is to present our series of 30 patients who underwent SCF repair for varying defects and to review the scope and outcome of SCF repair in the literature.MethodsThe authors contributed primary evidence of 30 cases of SCF repair. Our outcomes are compared with those reported in the last 5 years’ literature; 33 articles published between January 2012 and January 2017 that present original clinical experience of 528 SCFs.ResultsSCF is suitable for a wide variety of oral cavity, pharyngeal, skull base and cutaneous defects. Consistent with our experience, SCF is highly reliable even in previously irradiated or dissected necks, so long as the supraclavicular artery is intact. Our case series shows minor complications in 3/30 (10%) and flap loss in 1/30 (3.3%) cases. The literature reports a similar rate of complete flap failure of 3.4% and a slightly higher average minor complication rate of 24.6%.ConclusionWe add our experience of 30 cases of SCF repair to the international literature. We experienced a complication rate lower than the reported average, and maintain that the SCF is an excellent reconstructive option in patients with previously irradiated necks or comorbidities that affect microvasculature and anaesthetic resilience.
      PubDate: 2017-11-17T04:42:35.091879-05:
      DOI: 10.1111/ans.14263
       
  • Quality of handwritten surgical operative notes from surgical trainees: a
           noteworthy issue
    • Authors: Tatenda C. Nzenza; Todd Manning, Simeon Ngweso, Marlon Perera, Shomik Sengupta, Damien Bolton, Nathan Lawrentschuk
      Abstract: BackgroundSurgical operation notes are crucial for medical record keeping and information flow in continued patient care. In addition to inherent medical implications, the quality of operative notes also has important economic and medico-legal ramifications. Further, well-documented records can also be useful for audit purposes and propagation of research, facilitating the improvement of delivery of care to patients. We aimed to assess the quality of surgical operation notes written by junior doctors and trainees against a set standard, to ascertain whether these standards were met.MethodWe undertook an audit of Urology and General Surgery operation notes handwritten by junior doctors and surgical trainees in a tertiary teaching hospital over a month period both in 2014 and 2015. Individual operative notes were assessed for quality based on parameters described by the Royal College of Surgeons of England guidelines.ResultsBased on the Royal College of Surgeons of England guidelines, a significant proportion of analysed surgical operative notes were incomplete, with information pertaining to the time of surgery, name of anaesthetist and deep vein thrombosis prophylaxis in particular being recorded less than 50% of the time (22.42, 36.36 and 43.03%, respectively).Overall, 80% compliance was achieved in 14/20 standards and 100% compliance was attained in only one standard.ConclusionsThe quality of surgical operation notes written by junior doctors and trainees demonstrated significant deficiencies when compared against a set standard. There is a clear need to educate junior medical staff and to provide systems and ongoing education to improve quality. This would involve leadership from senior staff, ongoing audit and the development of systems that are part of the normal workflow to improve quality and compliance.
      PubDate: 2017-11-17T04:40:59.709544-05:
      DOI: 10.1111/ans.14239
       
  • Development of a surgical trainer assessment questionnaire
    • Authors: Benjamin J. F. Dean; Barrie Keeler, Patrick Garfjeld Roberts, Jonathan L. Rees
      Abstract: BackgroundThe assessment of surgical trainees has become well-established in practice; however, this is not yet the case for surgical trainers. The aim of this study was to develop a trainer assessment questionnaire (OxTrAQ) based on the 12 key trainer attributes identified by a previous systematic review, to then explore this questionnaire's potential domains and test its reliability.MethodsThe OxTrAQ was piloted at two surgical training centres in two surgical sub-specialities. At each centre, every trainee assessed every trainer while under their clinical supervision.ResultsInternal consistency (Cronbach's alpha) was calculated for this 12-item questionnaire as 0.958. Factor analysis revealed two domains which accounted for 77.997% of the variance; these were the general domain (nine items) and the independence domain (three items). Inter-observer reliability was shown by the intraclass correlation coefficients (ICCs) (average measures) for the overall OxTrAQ score, general domain score and independence domain score which were 0.951, 0.945 and 0.955 for centre 1 and 0.857, 0.819 and 0.883 for centre 2, respectively. Intra-observer reliability was shown by the ICCs (average measures) for the overall OxTrAQ score, general domain score and independence domain score which were 0.925, 0.913 and 0.940, respectively. Construct validity was demonstrated by a high correlation (Spearman rho = 0.886, P = 0.019) between trainer scores and the scores predicted by the trainers themselves.ConclusionsThe OxTrAQ is a simple trainer assessment questionnaire which has demonstrated both high inter- and intra-observer reliability.
      PubDate: 2017-11-13T17:30:57.370015-05:
      DOI: 10.1111/ans.14256
       
  • Current evidence for the use of N-acetylcysteine following liver resection
    • Authors: Richard Kemp; Jonathan Mole, Dhanny Gomez,
      Abstract: BackgroundN-acetylcysteine (NAC) has many uses in medicine; notable in the management of paracetamol toxicity, acute liver failure and liver surgery. The aim of this review was to critically appraise the published literature for the routine use of NAC in liver resection surgery.MethodsAn electronic search was performed of EBSCOhost (Medline and CINAHL database), PubMed and the Cochrane Library for the period 1990–2016. MeSH headings: ‘acetyl-cysteine’, ‘liver resection’ and ‘hepatectomy’ were used to identify all relevant articles published in English.ResultsFollowing the search criteria used, three articles were included. Two of these studies were randomized controlled trials. All the studies collated data on morbidity and mortality. All three studies did not show a significant difference in overall complications rates in patients that underwent hepatic resection that had NAC infusion compared with patients that did not. In one study, NAC administration was associated with a higher frequency of grade A post-hepatectomy liver failure. In another study, a significantly higher incidence of delirium was observed in the NAC group, which led to the trial to be terminated early.ConclusionThe current published data do not support the routine use of NAC following liver resection.
      PubDate: 2017-11-13T17:30:42.884022-05:
      DOI: 10.1111/ans.14295
       
  • Carotid endarterectomy: the change in practice over 11 years in a
           stroke centre
    • Authors: Gabrielle T. W. Tse; Monique F. Kilkenny, Chris Bladin, Michael Grigg, Helen M. Dewey
      Abstract: BackgroundRecent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large-volume stroke centre.MethodsAll patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome.ResultsThere were 510 CEAs performed during 2004–2014 and 95 CASs during 2003–2008. The proportion of patients undergoing CEA compared to CAS increased from 60% to 90% from 2004 to 2008 (P 
      PubDate: 2017-11-13T17:30:39.977095-05:
      DOI: 10.1111/ans.14241
       
  • Patent processus vaginalis as a conduit for tumoral seeding: a rare
           presentation of port site metastasis
    • Authors: Terence Yu Xi Law; Edmund Chiong
      PubDate: 2017-11-12T19:53:03.140318-05:
      DOI: 10.1111/ans.14253
       
  • Impact of web-based clinical practice guidelines on paediatric fracture
           clinics
    • Authors: Mark W. Camp; James R. Barnes, Mohita Damany, Leo T. Donnan
      Abstract: BackgroundIn an effort to standardize management and reduce over-treatment of uncomplicated paediatric fractures, the Victorian Pediatric Orthopaedic Network and the Royal Children's Hospital, Melbourne, created publically available web-based paediatric fracture pathways. The aim of this study was to determine the impact of web-based fracture pathways on the clinic volume at a tertiary-care paediatric fracture clinic.MethodsA comparative retrospective review was performed at a large, urban, tertiary-care children's hospital. Fracture clinic data from two 12-week periods before and after implementation of the fracture pathways were compared. For each study period, data collected included: total number of emergency department visits, number of fracture clinic visits, number of fracture clinic visits for patients that presented with upper extremity fractures for which web-based fracture pathways were available, number of radiology department visits for X-rays, and number of fracture clinic visits for patients requiring orthopaedic intervention in the operating room (closed or open reductions).ResultsThe number of fracture clinic visits for patients with upper extremity fractures decreased 12% post-pathway implementation, from 954 visits to 842 visits. The number of radiology department visits for patients with upper extremity fractures decreased 24% post-pathway implementation, from 714 to 544 visits.ConclusionThe implementation of web-based fracture pathways for upper extremity paediatric fractures was associated with a decrease in clinic resource utilization at a tertiary-care children's hospital.
      PubDate: 2017-11-12T19:52:49.594991-05:
      DOI: 10.1111/ans.14260
       
  • How to do breast reconstruction using free flaps with short pedicles: a
           stepwise technique for easier, safer anastomoses
    • Authors: Scott Ferris; Damien Grinsell, Hans H. M. Nielsen
      PubDate: 2017-11-12T19:52:47.485477-05:
      DOI: 10.1111/ans.14247
       
  • Out of sight, out of mind: perforated distal stump appendicitis
    • Authors: Khadijah Nadeem; Mathew O. Jacob, Ollapallil Jacob
      PubDate: 2017-11-12T19:52:31.020878-05:
      DOI: 10.1111/ans.14244
       
  • Quinke's triad: haemobilia secondary to hepatic artery aneurysm
    • Authors: Hani Saeed; Kenneth N. Buxey, Charles P. E. Milne, Geoffrey Cox
      PubDate: 2017-11-12T19:50:44.179902-05:
      DOI: 10.1111/ans.14250
       
  • Squamous cell carcinoma of unknown primary masquerading as multiple
           splenic abscesses
    • Authors: Jemima Xue; Aparajith Chandramouli, Mineesh Datta, Sayed Hassen, Rachel Wong
      PubDate: 2017-11-09T22:16:50.385579-05:
      DOI: 10.1111/ans.14242
       
  • Ischaemic colitis: uncertainty in diagnosis, pathophysiology and
           management
    • Authors: Amanda L. Nikolic; James O. Keck
      Abstract: Ischaemic colitis is the most common form of gastrointestinal ischaemia, but may be confused with acute mesenteric ischaemia, inflammatory bowel disease or infectious colitis. This review article outlines the current classification, epidemiology and risk factors, as well as approaches about diagnosis and management to guide clinical practice. It also identifies areas for further research.
      PubDate: 2017-11-09T22:16:46.445139-05:
      DOI: 10.1111/ans.14237
       
  • How should new orthopaedic implants be introduced: an example and
           recommendations for best practice
    • Authors: Richard Hannan; Varun Arora, Richard Beaver, Paul Harvie
      Abstract: Continued advancements in orthopaedics have led to the development of many new implants; many of these are being utilized in clinical practice with little or no evidence base for their safety or effectiveness. Highly publicized failures in orthopaedic technology have led to an increased awareness of this issue in both medical and non-medical circles. In most cases, the significant harm caused to the public could have been avoided by the appropriately staged implementation of new implants. This review comments on the current literature regarding the optimal practice for the introduction of new orthopaedic technology. The authors’ experience with the failed ESKA Adapter Short-stem/Modular Hip is described; the methodology used for its evaluation is used as a basis to discuss what was successful about the process and also give warning on what could be improved upon. The ideal practice requires new orthopaedic implants to be evaluated by high-volume surgeons in specialist orthopaedic hospitals. These studies should include biomechanical studies, radiostereophotometric analysis, implant retrieval and outcome assessment. Results and complications should be reported early to the appropriate joint registry and regulatory body. Once a suitable evidence base has developed, the implant can be distributed into wider clinical practice or withdrawn. These recommendations aim to protect the patient and public from harm while allowing surgical innovation to still continue.
      PubDate: 2017-11-09T22:16:43.848581-05:
      DOI: 10.1111/ans.14234
       
  • Lower risk of pelvic metalware infection with operative repair of
           concurrent bladder rupture
    • Authors: Henry H.-I. Yao; Max Esser, Jeremy Grummet, Chris Atkins, Peter Royce, Uri Hanegbi
      Abstract: BackgroundPatients with traumatic bladder rupture frequently have associated pelvic fracture. With increasing numbers of pelvic fractures fixed internally, there are concerns that conservative management of bladder rupture may increase the risk of pelvic metalware infection. This study aims to determine if operative repair of bladder rupture in comparison to conservative management with catheter drainage alone is associated with a lower rate of infection of internal fixation device for concurrent pelvic fracture.MethodsThis is a retrospective cohort study of level IV evidence. From July 2001 through June 2013, 45 multi-trauma patients at a level 1 trauma centre were identified to have sustained bladder rupture with concurrent pelvic fracture requiring internal fixation. Clinicopathological data were extracted from the TraumaNET database, medical records and health-coding database. Patients were stratified into two retrospective cohorts, management with surgical repair and management with catheter drainage alone. Fischer's exact test was used to determine whether the rate of pelvic metalware infection was different in the two cohorts.ResultsOf the 45 patients, 13 had intraperitoneal bladder rupture, 28 had extraperitoneal bladder rupture and four had combined intra-extraperitoneal bladder rupture. The median age for this cohort was 31. Bladder rupture was surgically repaired in 36 patients and managed conservatively with catheter drainage in nine patients. The rate of pelvic internal fixation device infection was lower in patients managed with surgical repair compared with conservative management (5.6% versus 33.3%, P = 0.047).ConclusionOperative repair of bladder rupture is associated with a lower rate of pelvic orthopaedic hardware infection in the presence of concurrent pelvic fracture requiring internal fixation.
      PubDate: 2017-11-09T22:16:39.825527-05:
      DOI: 10.1111/ans.14233
       
  • Protuberant heterotopic ossification following distal biceps tendon repair
    • Authors: Nicholas G. Holder; Adrian K. Schneider, Eugene T. Ek
      PubDate: 2017-11-09T22:16:21.907844-05:
      DOI: 10.1111/ans.14232
       
  • Safety of single-incision laparoscopic cholecystectomy for acute
           cholecystitis
    • Authors: Geon Young Byun; Sung Ryul Lee, Bum Hwan Koo
      Abstract: BackgroundSingle-incision laparoscopic cholecystectomy (SILC) is a common procedure performed worldwide. In this study, we evaluated the safety and efficacy of SILC for acute cholecystitis.MethodsPatients who underwent SILC between September 2012 and December 2016 were retrospectively enrolled and divided into acute and chronic groups. Demographic, operative and outcome data were obtained by reviewing medical records, physical examination and telephone follow-up.ResultsIn total, 1435 patients were included in this study: 220 (15.3%) in the acute group and 1215 (84.7%) in the chronic group. The mean operative time was longer in the acute group than in the chronic group (44.7 ± 21.6 versus 32.8 ± 9.8 min; P 
      PubDate: 2017-11-09T22:16:10.721-05:00
      DOI: 10.1111/ans.14246
       
  • Splenic vessel preservation versus splenic vessel resection in
           laparoscopic spleen-preserving distal pancreatectomy
    • Authors: Baohua Hou; Dailan Xiong, Sheng Chen, Tingting Ma, Chuanzhao Zhang, Yu Zhou, Zi Yin
      Abstract: BackgroundLaparoscopic spleen-preserving distal pancreatectomy for low-grade malignant pancreas tumours was recently demonstrated and can be performed with splenic vessel preservation (SVP) or splenic vessel resection (SVR). Whether one approach is superior to another is still a matter of debate.MethodsA systematic literature search (PubMed, Embase, Science Citation Index, Springer-Link and Cochrane Central Register of Controlled Trials) was performed. Pooled intra- and post-operative outcomes were evaluated. Stratified and sensitivity analyses were performed to explore heterogeneity between studies and to assess the effects of the study qualities.ResultsA total of six studies were included. There was no significant difference for SVR and SVP in terms of overall post-operative complications and the pooled odds ratio (OR) was 0.87 (95% confidence interval (CI) 0.55–1.38, I2 = 25%). Meta-analysis on the pooled outcome of intraoperative operative time and blood loss favoured SVR; the mean differences were 18.64 min (95% CI 6.91–30.37 min, I2 = 21%) and 65.67 mL (95% CI 18.88–112.45 mL, I2 = 48%), respectively. Subgroup analysis showed a decrease incidences in perigastric varices (OR = 0.07, 95% CI 0.03–0.18, I2 = 29%) and splenic infarction (OR = 0.16, 95% CI 0.08–0.32, I2 = 0%) in SVP.ConclusionFor selected patients who underwent laparoscopic spleen-preserving distal pancreatectomy, an increased preference for the SVP technique should be suggested considering its short-term benefits. However, in case of large tumours that distort and compress vessel course, SVR could be applied with acceptable splenic ischaemia and perigastric varices.
      PubDate: 2017-11-09T22:16:01.600092-05:
      DOI: 10.1111/ans.14190
       
  • Reconstructive options for large back free flap donor sites
    • Authors: Arshia Azizeddin; Peter F. M. Choong, Damien Grinsell
      Abstract: BackgroundReconstruction of posterior thoracic and trunk defects can prove challenging even to the most seasoned surgeons. Many commonly used techniques for closing back defects include primary closure and split skin grafts. Often times, however, other techniques are needed in order to give the patient the best aesthetic and functional outcome. In this study, we focus on and evaluate donor site closure techniques for defects in the back created by harvesting scapular and parascapular flaps.MethodsTwenty patients were operated on to remove pathologically diagnosed sarcomas using a wide local excision. The defects, ranging from 5 to 22 cm in width, were closed using donor flaps from the scapular/parascapular region. Nine donor sites were then closed primarily with wide undermining, while 11 donor sites were closed using multiple techniques, such as large transposition flaps, large rotation advancement flaps, keystone neurovascular island flaps, latissimus dorsi advancement flap and large Y-V advancement flaps.ResultsAll recipient and donor flaps survived with good aesthetic and functional outcome. Patient satisfaction was high and only two of 20 donor site flaps required further surgery due to wound dehiscence. No other complications were seen during the follow-up period.ConclusionThe proposed advanced techniques for donor site closure in back defects have shown that primary wound healing can be achieved with the use of a variety of different techniques and the avoidance of the complications of a skin graft.
      PubDate: 2017-11-09T22:15:53.443346-05:
      DOI: 10.1111/ans.14240
       
  • Jejuno-jejunal intussusception following gastrectomy
    • Authors: Vignesh Narasimhan; Geraldine Ooi
      PubDate: 2017-10-20T06:34:10.134686-05:
      DOI: 10.1111/ans.14222
       
  • Traumatic fracture dislocation of the thoracic spine sparing both the
           spinal cord and aorta
    • Authors: Michael Z. L. Zhu; Rejith V. Mannambeth, David C. McGiffin, Susan M. Liew
      PubDate: 2017-10-20T06:33:16.876166-05:
      DOI: 10.1111/ans.14230
       
  • Outcomes of percutaneous cholecystostomy and predictors of subsequent
           cholecystectomy
    • Authors: Scott Cooper; Michael Donovan, David A. Grieve
      Abstract: BackgroundThe use of a percutaneous cholecystostomy (PC) in the management of severe acute cholecystitis is a well recognized alternative to acute cholecystectomy. The need for definitive surgical management remains controversial.MethodsA retrospective analysis of hospital records at Nambour General Hospital between 2012 and 2016 was conducted and data relating to indications, demographics, comorbidities and outcomes were collected.ResultsThirty PC patients (20 male and 10 female) were identified, with a mean age of 77 years (range 46–93). Thirteen proceeded to cholecystectomy, nine elective and four emergent. Mean time to operation was 97 days (range 1–480). Ten were performed laparoscopically with a complication rate of 23% (3/13). One patient in the operative group died. Seventeen patients did not proceed to cholecystectomy. Fifteen resolved and were discharged, and two died. Three of those discharged were readmitted with gallstone disease requiring treatment, one of which died. A total of 71% (12/17) of the non-operative group died and three of those had a cause of death related to gallstone disease. The operative group was younger (P = 0.01) and had a lower estimated mortality risk (P 
      PubDate: 2017-10-20T06:30:49.19303-05:0
      DOI: 10.1111/ans.14251
       
  • Consecutive cases of thyrolipomatosis and thymolipoma: a case report
    • Authors: Anne Stanaway; Tracey Lam
      PubDate: 2017-10-18T00:47:18.544641-05:
      DOI: 10.1111/ans.14216
       
  • Adult intussusception: a rare but important clinical entity
    • Authors: Lucy Hinton; Stephen Kyle
      PubDate: 2017-10-18T00:46:59.699172-05:
      DOI: 10.1111/ans.14217
       
  • Unusual presentation of metastatic gastrointestinal stromal tumour
    • Authors: Hao-Yun Yap; Tze-Wei Chng, Brian K. P. Goh
      PubDate: 2017-10-18T00:46:38.394026-05:
      DOI: 10.1111/ans.14224
       
  • Firework-related injury in the Top End: a 16-year review
    • Authors: David J. Read; Richard Bradbury, Edward Yeboah
      Abstract: BackgroundOn July 1st on ‘Territory Day’, the public in the Northern Territory are permitted to purchase and operate consumer fireworks without a licence. Serious permanent injuries from fireworks are well described, leading to their banning in many other jurisdictions. This study describes those seriously injured by fireworks in the Top End of the Northern Territory, with the aim of identifying opportunities for prevention and harm minimization.MethodsThis is a retrospective audit of all admitted patients with an injury from fireworks at the Royal Darwin Hospital between 2000 and 2015. The variables collected included demographic data and the circumstances around injury (operator versus bystander, alcohol involvement and day of device operation). The consequences such as injuries, operating theatre visits, length of stay and outpatient visits are described.ResultsFifty-five patients (including 17 children) suffered 67 injuries over the study period, resulting in 68 operating theatre visits, 322 hospital days and 380 outpatient appointments. Burns, hand and eye injuries predominate. Females (P = 0.000) and children (P = 0.029) were more likely to be injured as bystanders. Injuries on a day other than Territory Day were more likely to have alcohol involvement (P = 0.01), and occur in the operator (P = 0.017).ConclusionConsumer firework usage results in a small number of life altering injuries annually. Previous prevention campaigns focusing on device user safety should be expanded to include the safety of bystanders and children and reduce firework usage outside of the Territory Day.
      PubDate: 2017-10-18T00:45:52.92071-05:0
      DOI: 10.1111/ans.14182
       
  • Ethnic disparities in rates of publicly funded bariatric surgery in New
           Zealand (2009–2014)
    • Authors: Jamie-Lee Rahiri; Mel Lauti, Matire Harwood, Andrew D. MacCormick, Andrew G. Hill
      Abstract: BackgroundPublicly funded bariatric surgery in New Zealand (NZ) is steadily on the rise to meet the obesity epidemic. Ethnic disparities in obesity rates exist in NZ with Māori and Pacific people having three to five times higher rates than all other ethnic groups within NZ. Ethnic disparities in rates of bariatric surgery have been reported internationally. This research sought to describe rates of publically funded bariatric surgery by self-identified ethnicity in NZ.MethodsUsing reported census and hospitalization discharge data from Statistics NZ and the NZ Ministry of Health, we calculated estimate rates of publicly funded bariatric surgery in the morbidly obese population from June 2009 to July 2014.ResultsThe average number of publicly funded bariatric procedures performed per 1000 morbidly obese patients from June 2009 to July 2014 was 3.0 for European, 1.4 for Māori and 0.7 for Pacific ethnicities.ConclusionWhile these data should be interpreted cautiously due to data limitations, the estimated rates may indicate that bariatric services are currently being provided inequitably across the major ethnic groups within NZ. We suggest that further studies should be performed to explore potential patient, healthcare provider and system-level factors that may contribute to ethnic disparities in the rates of publicly funded bariatric surgery in NZ.
      PubDate: 2017-10-18T00:45:50.634744-05:
      DOI: 10.1111/ans.14220
       
  • Trends in non-lactation breast abscesses in a tertiary hospital setting
    • Authors: Apoorva Saboo; Ian Bennett
      Abstract: BackgroundThe aim of this paper was to retrospectively review non-lactation breast abscesses treated in Princess Alexandra Hospital over a 10-year period and to illustrate the trends in size, risk factors, microbiological profile and management.MethodsA computerized search of the medical records was undertaken to identify all adult patients with a diagnosis of breast abscesses during June 2005–June 2015. Patients concurrently breastfeeding were excluded. A retrospectively review of the clinical records was performed.ResultsEighty-five abscesses were identified in 77 patients. The median patient age was 45 years and 93.7% were females. Smoking and diabetes mellitus were associated with a longer inpatient hospital stay. There was a significant difference in microbiology of abscesses in relation to size. Smaller abscesses (≤3.0 cm) predominantly had mixed anaerobes (54%), whereas larger abscesses had a dominance of Staphylococcus aureus (29%) and other aerobic microbes (33%) (P 
      PubDate: 2017-10-18T00:45:48.631446-05:
      DOI: 10.1111/ans.14146
       
  • Blunt cerebrovascular injury: early recognition and treatment options in
           asymptomatic patient
    • Authors: Alexander Becker; Dror Ashkenazi, Dan Hershko
      PubDate: 2017-10-13T05:22:09.489251-05:
      DOI: 10.1111/ans.14159
       
  • Rare case of Bouveret syndrome
    • Authors: Angelina Marina Di Re; Gratian Punch, Arthur J. Richardson, Henry Pleass
      PubDate: 2017-10-13T02:25:58.163743-05:
      DOI: 10.1111/ans.14215
       
  • Laparoscopic ventral hernia repair using only 5-mm ports
    • Authors: Nicholas Bell-Allen; Harriet O'Rourke, Lisa Hong, Nicholas O'Rourke
      Abstract: BackgroundThe technique of laparoscopic ventral hernia repair has been evolving since it was first described over 20 years ago. We report a new technique where polyester mesh was back loaded through a 5-mm port site, coming into contact with the skin. This avoids the need for any 10–12-mm ports.MethodsA prospective database of laparoscopic ventral hernia repairs was examined. A single surgeon performed 344 laparoscopic ventral hernia repairs using this technique over 60 months. Follow-up was conducted by both clinical and independent phone review. Surgical technique: Laparoscopic access was achieved via a 5-mm optical port, adding two, or occasionally three, 5-mm extra ports. Hernia contents were reduced and the extra-peritoneal fat excised; 5-mm tooth graspers were placed through the lateral port and then in a retrograde fashion through the uppermost port. The port was removed, and the mesh pulled back into the abdominal cavity and positioned with a minimum of 3-cm overlap. The mesh was fixed using absorbable tacks and sutures.ResultsMost patients had primary umbilical hernias. There was one case of mesh infection due to enteric organisms. This occurred in a patient undergoing repair of a stoma site hernia, resulting from a Hartmann's procedure for perforated diverticulitis. There was no other evidence of acute or chronic mesh infection despite cutaneous contact with the mesh. In this series, there was an overall hernia recurrence rate of 2.4%.ConclusionLaparoscopic ventral hernia repair using only 5-mm ports is a safe, effective technique with no extra risk of infection.
      PubDate: 2017-10-12T23:35:58.342098-05:
      DOI: 10.1111/ans.13985
       
  • Littoral cell angioma of spleen
    • Authors: Van Truong; Robert Finch, Benjamin Martin, Kate Buzacott, Mahendra Singh, Bhavik Patel
      PubDate: 2017-10-11T17:51:15.313508-05:
      DOI: 10.1111/ans.14193
       
  • Hepatic cystic echinococcosis in Australia: an update on diagnosis and
           management
    • Authors: Ben Keong; Bruce Wilkie, Tom Sutherland, Adrian Fox
      Abstract: BackgroundEchinococcosis is an uncommonly encountered zoonotic disease caused by the taeniid Echinococcus. The only endemic species in Australia, Echinococcus granulosus, forms cysts in the liver in 70% of cases. The aim of this study was to review the literature to provide an evidence-based narrative update on the diagnosis and management of hepatic cystic echinococcosis in Australia.MethodsWe reviewed the literature, utilizing multiple research databases and citation tracking. Original research and review articles examining the diagnosis and management of hydatid disease in adults, published prior to 2016 and in the English language were included in our review.ResultsUltrasound is the gold-standard screening test, whilst computed tomography has a role in emergency presentations and screening for multi-organ involvement. Magnetic resonance imaging is the preferred second-line imaging and better demonstrates biliary involvement. Medical therapy or PAIR (percutaneous aspiration, irrigation with scolicide and re-aspiration) may be appropriate in selected cases; however, surgery remains the definitive treatment for active, large (>5 cm), symptomatic or complicated cysts. A variety of surgical techniques have been described, including conservative, radical and minimally invasive procedures. There is currently no consensus approach; surgical modality should be tailored to patient factors, relevant anatomy, local facilities and surgeons’ expertise.ConclusionDiagnosis and therapy in hepatic hydatid cysts have been significantly advanced by imaging, interventional radiology and surgical approaches in recent years. Surgery remains the mainstay of treatment for large, active, complicated or symptomatic hepatic hydatid cysts.
      PubDate: 2017-10-11T17:51:01.490545-05:
      DOI: 10.1111/ans.14117
       
  • Revision gastric bypass after laparoscopic adjustable gastric band: a
           10-year experience at a public teaching hospital
    • Authors: James Carroll; Michael Kwok, Bhavik Patel, George Hopkins
      Abstract: BackgroundIn Australia, there is limited access to public revisional bariatric procedures. However, the need for such procedures is rising. We investigated the safety and efficacy of band-to-bypass procedures in our experience at a public teaching hospital over a period of 10 years.MethodsUsing a prospectively maintained bariatric surgical database, we analysed 91 consecutive planned band-to-bypass procedures from 2007 to November 2016. All patients had prior laparoscopic adjustable gastric bands removed and formation of Roux-en-Y gastric bypass, in one or two stages. Primary outcomes were 30-day complication rate and excess weight loss from 12 months. The impact of fellows as primary operators on these outcomes was assessed.ResultsEighty-two patients met the inclusion criteria. Seventy-one (84.5%) were females. Mean age was 48.8 years (SD: 8.85). Immediate post-operative complications included six (7.3%) patients with gastrojejunostomy leak, three of whom required conversion to laparotomy, with one mortality (1.22%). Fifty-two patients had follow-up of 1 year or more (median: 2.36, range: 1–9.24). Mean excess weight loss at the end of follow-up was 52.79% (SD: 46.46). Twenty-eight (34.14%) cases were performed primarily by a fellow under the guidance of an experienced bariatric surgeon, with equivalent results.ConclusionRevisional band-to-bypass in the public setting is an effective but complex procedure associated with morbidity. Some risk may be ameliorated by development of selection criteria to exclude certain high-risk groups. We hope discussion amongst other bariatric groups will further refine this approach.
      PubDate: 2017-10-11T17:50:52.174738-05:
      DOI: 10.1111/ans.14114
       
  • Effect of a See and Treat clinic on skin cancer treatment time
    • Authors: Scott J. P. McLaughlin; John Kenealy, Michelle B. Locke
      Abstract: BackgroundMany plastic surgery departments in Australasia have experienced increasing referrals for management of skin lesions. This has driven a demand for new strategies to decrease patient waiting time and administrative costs. The aim of this study was to determine if a purpose-built See and Treat skin cancer clinic could provide a faster skin cancer treatment pathway with comparable clinical outcomes and acceptability to patients.MethodsThis was a prospective observational study of patients treated through the See and Treat clinic with a retrospective control cohort. The prospective ‘See and Treat’ cohort included a consecutive series of 106 patients, while the retrospective cohort included a consecutive series of 200 patients. Patient demographics, time from referral to surgery and operative measures were analysed. One hundred patients in the prospective cohort completed an anonymous satisfaction survey regarding their treatment.ResultsThe average time from referral to surgery was reduced from 121 days in the retrospective cohort to 60 days in the See and Treat cohort (P 
      PubDate: 2017-10-11T17:50:50.461762-05:
      DOI: 10.1111/ans.14110
       
  • Laparoscopic pancreaticoduodenectomy in Brisbane, Australia: an initial
           experience
    • Authors: Bhavik Patel; Universe Leung, Jerry Lee, Richard Bryant, Nicholas O'Rourke, David Cavallucci
      Abstract: BackgroundThe role of minimally invasive approach for pancreaticoduodenectomy has not yet been well defined in Australia. We present our early experience with laparoscopic pancreaticoduodenectomy (LPD) from Brisbane, Australia.MethodsRetrospective review in a prospectively collected database of patients undergoing LPD between 2006 and 2016 was performed. Patients who underwent a hybrid LPD (HLPD) mobilization approach and resection followed by open reconstruction and totally LPD (TLPD) approach were included in this study. Operative characteristics, perioperative outcomes, pathological and survival data were collected.ResultsTwenty-seven patients underwent LPD including 17 HLPD (63%) and 10 TLPD (37%) patients. HLPD patients were mostly converted to open for planned reconstruction or vascular resection. With increasing experience, more TLPDs were performed, including laparoscopic anastomoses. Median operating time was 462 min (504 min for TLPD). Median length of hospital stay was 10 days. Histology showed 21 invasive malignancies, two neuroendocrine tumours, two intraductal papillary mucinous neoplasms and two benign lesions. Median nodal harvest was 22. Margin negative resection was achieved in 84% of patients. Twenty-two percent of patients developed a Grade 3/4 complication, including 19% clinically significant pancreatic fistula. There was one perioperative mortality (4%) due to pancreatic fistula, post-operative haemorrhage and sepsis.ConclusionsLPD is a technically challenging operation with a steep learning curve. The early oncological outcomes appear satisfactory. It remains to be determined whether the minimally invasive approach to pancreaticoduodenectomy offers benefits to patients
      PubDate: 2017-10-11T17:50:29.0434-05:00
      DOI: 10.1111/ans.14020
       
  • Transcatheter embolization of a large mediastinal bronchial artery
           aneurysm with short neck
    • Authors: Yonggeng Goh; Prapul C. Rajendran, Stanley E. K. Loh, Andrew M. T. L. Choong, Sheldon J. K. Ng, Bernard Wee
      PubDate: 2017-10-09T21:21:23.759879-05:
      DOI: 10.1111/ans.14198
       
  • Review of appendicectomies over a decade in a tertiary hospital in New
           Zealand
    • Authors: Kirsten J. de Burlet; Grant Crane, Ruth Cullinane, Peter D. Larsen, Elizabeth R. Dennett
      Abstract: BackgroundAcute appendicectomy is the most common emergency operation for patients with abdominal pain. In the last decade, computed tomography (CT) scans have increasingly been used to aid in the diagnosis in order to reduce the negative appendicectomy rate. The aim of this study was to evaluate our institution's negative appendicectomy rate and the use of pre-operative imaging.MethodsA retrospective review was undertaken for all adult patients (>16 years), who underwent an appendicectomy on emergency basis in the years 2004, 2009 and 2014. Cases were identified from the hospital electronic theatre record system. Data were also obtained from the patients records and laboratory reports.ResultsA total of 874 patients were included, 227 in 2004, 308 in 2009 and 339 in 2014. The negative appendicectomy rate was 29.1% in 2004, 20.1% in 2009 and 19.5% in 2014 (P = 0.014). Negative appendicectomies were more common in women (P = 
      PubDate: 2017-10-09T21:21:00.543184-05:
      DOI: 10.1111/ans.14203
       
  • Natural history of endoscopically detected hiatus herniae at late
           follow-up
    • Authors: Syeda Khadijah Ahmed; Tim Bright, David I. Watson
      Abstract: BackgroundHiatus herniae are commonly seen at endoscopy. Many patients with a large hiatus hernia are endoscoped for symptoms associated with the hernia and many of these will progress to surgical treatment. However, little is known about the natural history of small to medium size hiatus herniae, and their risk of progressing to a larger hernia requiring surgery. This study aims to determine the need for subsequent surgery in these patients.MethodsA retrospective audit of the endoscopy database at Flinders Medical Centre and the Repatriation General Hospital in Adelaide, South Australia for the 2-year period 2002–2003 was performed to identify all patients with a hiatus hernia. Patients under the age of 65 and with a sliding hiatus hernia 10 years) outcome of these herniae.ResultsSmall- to medium-sized hiatus herniae (
      PubDate: 2017-10-09T21:20:52.268193-05:
      DOI: 10.1111/ans.14180
       
  • Unusual presentation of long-lost inferior vena cava filter
    • Authors: Nicola Davis; Andrew D. MacCormick, Stuart Caldwell
      PubDate: 2017-10-05T18:44:23.35788-05:0
      DOI: 10.1111/ans.14219
       
  • Anastomotic stricture: a complication of endoscopic choledochoduodenostomy
    • Authors: Tegan Ormston; David Devonshire, Daniel Croagh
      PubDate: 2017-10-05T18:44:01.237172-05:
      DOI: 10.1111/ans.14211
       
  • Rare cause of colitis with calcified mesenteric veins
    • Authors: Steward Tsz Kiu Chan; Chi Chung Foo, Wai Lun Law
      PubDate: 2017-10-05T18:43:39.660644-05:
      DOI: 10.1111/ans.14212
       
  • Cystic pheochromocytoma masquerading as a cystic pancreatic tumour
    • Authors: Vipul D. Yagnik; Vismit Joshipura, Rajnikant Sadhu
      PubDate: 2017-10-05T18:43:00.164277-05:
      DOI: 10.1111/ans.14213
       
  • Not all abdominal wall masses in women are endometriomas or desmoids;
           endometriosis-associated abdominal wall cancer
    • Authors: Leigh Archer; Daniel Wong, Robert Nairn, Rupert Hodder
      PubDate: 2017-10-05T18:42:37.199092-05:
      DOI: 10.1111/ans.14199
       
  • Unique case of a laparoscopic hand-assisted repair of an intramesosigmoid
           hernia causing bowel obstruction in a virgin abdomen
    • Authors: Krish Kulendran; Cian Keogh, Merwe Hartslief
      PubDate: 2017-10-05T18:42:17.400416-05:
      DOI: 10.1111/ans.14206
       
  • Internal hernia as a rare cause of ischaemic colitis: a case report and
           literature review
    • Authors: David Lan Cheong Wah; Adrian Tam, Anamitra Sarkar
      PubDate: 2017-10-05T18:41:56.68763-05:0
      DOI: 10.1111/ans.14202
       
  • Primary salivary gland malignancies: a review of clinicopathological
           evolution, molecular mechanisms and management
    • Authors: James Badlani; Ruta Gupta, Deepak Balasubramanian, Joel Smith, Peter Luk, Jonathan Clark
      Abstract: Salivary gland cancers are a complex group of tumours with variations in location, type and grade, all of which influence their biological behaviour. The understanding of salivary gland pathology has evolved at the molecular level in the last decade leading to identification of distinct entities, development of improved methods of diagnosis as well as identifying therapeutic targets for selected high-grade tumours. This article focuses on these advances and their impact on the management of primary salivary gland cancers.
      PubDate: 2017-10-05T18:41:14.135047-05:
      DOI: 10.1111/ans.14201
       
  • Study on the time taken for patients to achieve the ability to self-care
           their new stoma
    • Authors: Joshua Goldblatt; Ken Buxey, Eldho Paul, Rebecca Foot-Connolly, Tristan Leech, Stephen Bell
      Abstract: BackgroundStoma formation in colorectal surgery is a recognized independent cause of prolonged hospital stay. It has been shown that preoperative stoma education and siting leads to a reduction in the length of hospital stay. Despite this, the length of time to independent stoma management and the variables that affect this has not been well studied. We conducted a prospective case series to analyse this.MethodsA total of 107 consecutive colorectal surgery patients undergoing stoma formation at two separate large metropolitan hospitals, one private funded and the other government funded, were enrolled in a prospective case series. The primary outcome evaluated was independent management of stoma at discharge from hospital. Logistic regression analysis was performed to determine the factors associated with achieving independent stoma management at discharge.ResultsThe median length of stay was 9 days (range: 4–71). In our study, 71% of patients achieved self-care at the time of discharge from hospital (76/107 patients). The median length of time taken to achieve independent management of a stoma was 7 days (interquartile range: 6–9). Factors associated with increased chance of independent management of stoma at discharge included younger age, male, preoperative siting and treatment in a public hospital.ConclusionOur study supports that preoperative stoma education in combination with post-operative stoma education is superior to post-operative stoma education alone. Interestingly, treatment in a private hospital is associated with a higher likelihood of failure to achieve independent stoma management at discharge. This is unexpected and not explained by our data.
      PubDate: 2017-10-05T18:41:12.059203-05:
      DOI: 10.1111/ans.14195
       
  • Emergency pancreatic resection for glucagonoma associated with severe
           necrolytic migratory erythema
    • Authors: Daniel M. Daly; Benjamin Thompson, Julia Low, Jacqui Slater, Glenda Wood, Vasanth Kamath, Koroush S. Haghighi
      PubDate: 2017-10-05T18:41:08.091704-05:
      DOI: 10.1111/ans.14186
       
  • Cost-effective imaging for resectability of liver lesions in colorectal
           cancer: an economic decision model
    • Authors: Sopany Saing; Phil Haywood, Joanna K. Duncan, Ning Ma, Alun L. Cameron, Stephen Goodall
      Abstract: BackgroundThis study aimed to determine the cost-effectiveness of contrast-enhanced magnetic resonance imaging (CE-MRI) compared with multiphase CE computed tomography (CE-CT) scan to characterize suspected liver lesions in patients with known colorectal carcinoma.MethodsA decision analytic model linking diagnostic accuracy to health outcomes in patients with colorectal carcinoma was constructed. The model assumed that CE-MRI has superior sensitivity and equivalent specificity to CE-CT, and patients with a colorectal liver metastasis could be eligible for curative surgery or chemotherapy and palliation. Delayed diagnosis or misdiagnosis was associated with worse health outcomes (disutility). Cost-effectiveness was calculated as the incremental cost relative to the incremental benefit, the benefit was estimated using quality-adjusted life years. Sensitivity analyses were conducted to test the robustness of the results.ResultsThe clinical evidence supports increased sensitivity of CE-MRI compared with CE-CT (0.943 versus 0.768). CE-MRI was more effective and more costly than CE-CT. The incremental cost-effectiveness ratio was estimated to be $40 548 per quality-adjusted life year gained. The model is most sensitive to the cost of MRI, cost of palliative treatment and the disutility associated with delayed palliative care. The results were also sensitive to the assumptions made about the clinical algorithm.ConclusionThe results provide evidence of the potential cost-effectiveness associated with CE-MRI for the diagnosis of liver metastases in patients with identified colorectal carcinoma. CE-MRI can be recommended as cost-effective provided it replaces CE-CT and that improved diagnostic accuracy results in earlier, curative, disease management.
      PubDate: 2017-10-05T18:40:36.932573-05:
      DOI: 10.1111/ans.14194
       
  • Comparing pathological complete response rate using oral capecitabine
           versus infusional 5-fluorouracil with preoperative radiotherapy in rectal
           cancer treatment
    • Authors: Narotam Jootun; Tess Evans, Jackie Mak, Greg Makin, Cameron Platell
      Abstract: BackgroundInfusional 5-fluorouracil (5-FU) has been the standard radiation sensitizer in patients undergoing preoperative long-course chemoradiotherapy (CRT) for locally advanced rectal cancer in Australia. Capecitabine (Xeloda) is an oral 5-FU prodrug of comparable pharmacodynamic activity, currently preferred in place of 5-FU infusion, its established counterpart in neoadjuvant CRT for rectal cancer. The few studies quantifying pathological complete response (pCR) of Xeloda versus 5-FU have produced inconsistent results. We reviewed our own data to determine if the rates of pCR of oral capecitabine were non-inferior to intravenous 5-FU in patients undergoing neoadjuvant CRT for rectal cancer.MethodsA retrospective study was performed from a prospectively kept database. Four hundred and fifty-two patients received preoperative CRT from January 2006 to January 2016. Pelvic radiotherapy was delivered concurrently with capecitabine (n = 42) or infusional 5-FU (n = 341). The remaining received different chemotherapy regimens. Surgery was performed 6–12 weeks of CRT completion. Pathological responses were assessed using Dworak regression grading score (0–4). Clinical outcomes were evaluated in terms of local control and recurrence-free survival.ResultsThe proportion of patients who had a tumour regression score of 4 (pCR) after CRT was 4/42 (9.5%) in the capecitabine group and 71/341 (20%) in the infusional 5-FU group (P = 0.082). pCR was an independent predictor for survival in this group of patients (hazard ratio: 0.002, P = 0.0001, 95% confidence interval: 0.0001–0.027).ConclusionThe use of capecitabine as neoadjuvant chemotherapy in patients with rectal cancer was associated with a reduced rate of pCR. However this difference did not achieve statistical significance.
      PubDate: 2017-10-05T18:40:34.161892-05:
      DOI: 10.1111/ans.14192
       
  • Pancreatoduodenectomy in a public versus private teaching hospital is
           comparable with some minor variations
    • Authors: Terence C. Chua; Anubhav Mittal, Chris Nahm, Thomas J. Hugh, Jenny Arena, Anthony J. Gill, Jaswinder S. Samra
      Abstract: BackgroundThe impact of the public and private hospital systems on major abdominal operations that are demanding on clinical resources, such as pancreatic surgery, has not been explored in an Australian setting. This study examines the perioperative outcome of patients undergoing pancreatoduodenectomy (PD) at a major public and private hospital.MethodsPatients undergoing PD between January 2004 and October 2015 were classified based on their health insurance status and location of where the surgery was performed. Clinical variables relating to perioperative outcome were retrieved and compared using univariate and multivariate analyses.ResultsFour hundred and twenty patients underwent PD of whom 232 patients (55%) were operated on in the private hospital. Overall, there was no difference in morbidity and mortality in the public versus the private hospital. However, there were variations in public versus private hospital, this included longer duration of surgery (443 min versus 372 min; P 
      PubDate: 2017-10-05T18:40:31.074052-05:
      DOI: 10.1111/ans.14191
       
  • Urgent closed reduction of the dislocated cervical spine in New Zealand
    • Authors: Richard N. Storey; Raj Singhal, Tom Inglis, David Kieser, Rowan Schouten
      Abstract: BackgroundEmergent decompression, either by closed reduction or surgical decompression, of the acutely compressed cervical spinal cord is recognized as important in minimizing the neurological outcomes of these injuries. The aim of this study is to optimize New Zealand's capability to perform closed reductions.MethodsRegional hospitals throughout New Zealand were surveyed on their capability to reduce acute cervical spine dislocations using traction. A systematic literature review was performed to investigate aspects of patient selection, reduction technique and the outcomes achieved with closed reduction of such injuries. This information was combined with our local experience to develop an evidence-based guideline.ResultsMost (12/14) of the regional centres throughout New Zealand have recent experience, remain willing and have the resources necessary to reduce appropriate cervical spine injuries using traction. Fourteen published studies from nine countries detail a 75% success rate from 363 cases of attempted closed reduction, with the greatest neurological recovery noted in patients with shorter time period from injury to reduction. One patient suffered neurological worsening. The published protocols were compared and coupled with our local practice to create an online, step-by-step, evidence-based reference to help clinicians in regional hospitals perform a safe and successful closed reduction.ConclusionTo optimize the capability of inexperienced personnel to perform closed reductions in a safe and timely manner, we have developed an online, step-by-step, evidence-based reference (www.closedreduction.co.nz). This forms part of New Zealand's strategy to achieve urgent cord decompression for appropriate cervical spinal cord injuries.
      PubDate: 2017-09-28T02:30:31.297213-05:
      DOI: 10.1111/ans.14231
       
  • Bloating due to massive seminoma in an undescended testis
    • Authors: Julia L. Zhu; Matthew J. Roberts, Anojan Navaratnam, Eric Chung, Simon T. Wood
      PubDate: 2017-09-25T05:45:37.426467-05:
      DOI: 10.1111/ans.14155
       
  • Immediate autologous breast reconstruction after neoadjuvant
           chemoradiotherapy for breast cancer: initial results of the first 29
           patients
    • Authors: Damien Grinsell; Meron Pitcher, Shirley Wong, Mario Guerrieri, Hans H. M. Nielsen
      Abstract: BackgroundBreast reconstruction after mastectomy in the treatment of locally advanced breast cancer is often done in stages and before radiotherapy. We have previously published an algorithm for immediate free autologous reconstruction after neoadjuvant chemotherapy and preoperative radiotherapy. This protocol was designed to provide a shorter and simpler reconstructive path whilst improving cosmesis and maintaining oncological efficiency.MethodsA total of 29 patients were included and underwent surgery for 30 cancers by the first author between 2010 and September 2015. Data were prospectively entered into a database and analysed for tumour size, chemotherapeutic response, lymph node involvement, surgical complications and tumour recurrence.ResultsThe mean age was 55 ± 7 years. Eighty percent of patients had either a partial or complete chemotherapeutic response defined as>25% decrease in tumour size. Twenty-eight patients had free abdominal tissue transfer. One patient was excluded due to advanced disease. There were no take-backs due to microsurgical issues. One patient was reoperated on for a haematoma. Four patients had recurrent cancer during follow-up, three of whom are deceased.ConclusionMany, but not all, breast reconstructive surgeons consider autologous reconstruction as the ‘gold’ standard in the presence of radiotherapy. Rearranging the order of radiotherapy and surgery means operating in a recently irradiated field. We believe the surgical challenges are outweighed by a shorter and simpler reconstructive journey that additionally results in a better cosmesis. It is possible to perform immediate free autologous reconstruction after neoadjuvant chemotherapy and preoperative radiotherapy with excellent results and at least equivalent oncological efficacy.
      PubDate: 2017-09-24T21:16:29.502418-05:
      DOI: 10.1111/ans.14079
       
  • Arthroscopic, open and mini-open approach for rotator cuff repair: no
           difference in pain or function at 24 months
    • Authors: Elizabeth C. Bond; Lynette Hunt, Matthew J. Brick, Warren B. Leigh, Anthony Maher, Simon W. Young, Michael A. Caughey
      Abstract: BackgroundThe New Zealand Rotator Cuff Registry was established in 2009 to collect prospective functional, pain and outcome data on patients undergoing rotator cuff repair (RCR).MethodsInformation collected included an operation day technical questionnaire completed by the surgeon and Flex Shoulder Function (SF) functional and pain scores preoperatively, immediately post-operatively and at 6, 12 and 24 months. A multivariate analysis was performed analysing the three surgical approaches to determine if there was a difference in pain or functional outcome scores.ResultsA total of 2418 RCRs were included in this paper. There were 418 (17.3%) arthroscopic, 956 (39.5%) mini-open and 1044 (43.2%) open procedures. Twenty-four-month follow-up data were obtained for pain and Flex SF in 71% of patients. At 24 months, there was no difference in the average Flex SF score for the arthroscopic, mini-open and open groups. There was no difference in improvement in Flex SF score at 24 months. At 24 months, there was no difference in mean pain scores. There was no difference in improvement in pain score from preoperation to 24 months. Most patients returned to work within 3 months of surgery, with no difference between the three surgical approaches.ConclusionRCR has good to excellent outcomes in terms of improvement in pain and function at 2-year follow-up. We found no difference in pain or functional outcome at 24 months between arthroscopic, open and mini-open approaches for RCR.
      PubDate: 2017-09-21T18:00:44.06191-05:0
      DOI: 10.1111/ans.14176
       
  • Unicortical and bicortical plating in the fixation of comminuted fractures
           of the clavicle: a biomechanical study
    • Authors: John M. Looft; Lincoln Corrêa, Minoo Patel, Mathew Rawlings, David C. Ackland
      Abstract: BackgroundIntraoperative neurovascular complications with clavicle fracture fixation are often due to far cortex penetration by drills and screws, but could be avoided using a unicortical construct. The objective of this study was to compare the bending and torsional strength of a unicortical locking screw plate construct and a hybrid (with central locked and outer non-locked long oblique screws) unicortical plate construct for clavicle fracture fixation with that of a conventional bicortical locking screw construct of plate fixation.MethodsTwenty-four human clavicle specimens were harvested and fractured in a comminuted mid-shaft butterfly configuration. Clavicles were randomly allocated to three surgical fixation groups: unicortical locking screw, bicortical locking screw and hybrid unicortical screw fixation. Clavicles were tested in torsion and cantilever bending. Construct bending and torsional stiffness were measured, as well as ultimate strength in bending.ResultsThere were no significant differences in bending stiffness or ultimate bending moment between all three plating techniques. The unicortical locked construct had similar torsional stiffness compared with the bicortical locked construct; however, the hybrid technique was found to have significantly lower torsional stiffness to that of the bicortical locking screw construct (mean difference: 87.5 Nmm/degree, P = 0.028).ConclusionsUnicortical locked screw plate fixation and hybrid unicortical plating fixation with centrally locked screws and outer long, oblique screws may alleviate far cortex penetration, protecting nearby anatomical structures, and may ease implant removal and conversion to bicortical fixation for revision surgery; however, use of long oblique screws may increase the risk of early loosening under torsion.
      PubDate: 2017-09-18T18:46:13.069049-05:
      DOI: 10.1111/ans.14139
       
  • Resection accuracy of patient-specific cutting guides in total knee
           replacement
    • Authors: Gregory C. Wernecke; Scott Taylor, Penny Wernecke, Samuel J. MacDessi, Darren B. Chen
      Abstract: BackgroundPatient-specific guides (PSGs) have been thoroughly investigated with regards to reconstitution of mechanical alignment in total knee arthroplasty (TKA). The ability to replicate the preoperative surgical plan is essential for optimal outcomes but intraoperative measurements to confirm accurate progression through the operation are limited. This leads to our clinical question: can PSGs replicate the planned bone resection depth during TKA'MethodsThis is a prospective case series of 118 patients who underwent TKA using magnetic resonance imaging-based patient-specific cutting guides. Intraoperative bone resection thickness was measured and compared with the preoperative planned bone resections as a primary outcome. Secondary outcomes included the need for additional bone resections, the number of cases for which the PSG technique was abandoned, final component sizes and mechanical alignment.ResultsPSGs could not accurately recreate preoperative plan. PSGs resulted in over-resection in all bone cuts compared with the preoperative surgical resection plan. Secondary osteotomies were required in 37% of patients. PSGs had to be abandoned in 10.5% of cases, mostly due to suboptimal fit of the femoral block. The tibial component size was altered more frequently than the femoral.ConclusionIntraoperatively, PSGs could not accurately recreate the preoperative plan. PSGs are marketed as user-friendly tools to simplify TKA but our research demonstrates the need for surgeons to monitor surgical progression and compensate for errors occurring during the use of PSGs.
      PubDate: 2017-08-29T22:40:32.564982-05:
      DOI: 10.1111/ans.14143
       
  • Issue information - JEB
    • Pages: 853 - 853
      PubDate: 2017-11-02T19:03:08.83723-05:0
      DOI: 10.1111/ans.14281
       
  • Issue information - TOC
    • Pages: 856 - 857
      PubDate: 2017-11-02T19:03:09.343179-05:
      DOI: 10.1111/ans.13783
       
  • Laparoscopic and other colorectal trials: ethics of the learning curve
    • Authors: Tony Eyers
      Pages: 859 - 859
      PubDate: 2017-11-02T19:03:10.985508-05:
      DOI: 10.1111/ans.14165
       
  • Out-of-office hours intensive care admissions: implications for hospital
           governance
    • Authors: Ian C. Bennett
      Pages: 860 - 860
      PubDate: 2017-11-02T19:03:08.50226-05:0
      DOI: 10.1111/ans.14171
       
  • Should colorectal surgeons continue to use nonsteroidal anti-inflammatory
           drugs'
    • Authors: Tarik Sammour; Andrew G. Hill
      Pages: 861 - 862
      PubDate: 2017-03-15T19:20:53.753987-05:
      DOI: 10.1111/ans.13621
       
  • Rectal cancer: so many surgical options. How do we choose'
    • Authors: Matthew J. F. X. Rickard
      Pages: 862 - 863
      PubDate: 2017-11-02T19:03:11.801106-05:
      DOI: 10.1111/ans.14204
       
  • Medicine in small doses
    • Authors: Bruce P. Waxman
      Pages: 864 - 864
      PubDate: 2017-11-02T19:03:05.440538-05:
      DOI: 10.1111/ans.14226
       
  • 25, 50 & 75 years ago
    • Authors: John P. Harris
      Pages: 865 - 866
      PubDate: 2017-11-02T19:03:03.848907-05:
      DOI: 10.1111/ans.14221
       
  • Mental training in surgical education: a systematic review
    • Authors: Sara Davison; Nicholas Raison, Muhammad S. Khan, Prokar Dasgupta, Kamran Ahmed
      Pages: 873 - 878
      Abstract: BackgroundPressures on surgical education from restricted working hours and increasing scrutiny of outcomes have been compounded by the development of highly technical surgical procedures requiring additional specialist training. Mental training (MT), the act of performing motor tasks in the ‘mind's eye’, offers the potential for training outside the operating room. However, the technique is yet to be formally incorporated in surgical curricula. This study aims to review the available literature to determine the role of MT in surgical education.MethodsEMBASE and Medline databases were searched. The primary outcome measure was surgical proficiency following training. Secondary analyses examined training duration, forms of MT and trainees level of experience. Study quality was assessed using Consolidated Standards of Reporting Trials scores or Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group.ResultsFourteen trials with 618 participants met the inclusion criteria, of which 11 were randomized and three longitudinal. Ten studies found MT to be beneficial. Mental rehearsal was the most commonly used form of training. No significant correlation was found between the length of MT and outcomes. MT benefitted expert surgeons more than medical students or novice surgeons.ConclusionThe majority studies demonstrate MT to be beneficial in surgical education especially amongst more experienced surgeons within a well-structured MT programme. However, overall studies were low quality, lacked sufficient methodology and suffered from small sample sizes. For these reasons, further research is required to determine optimal role of MT as a supplementary educational tool within the surgical curriculum.
      PubDate: 2017-08-29T05:05:44.833244-05:
      DOI: 10.1111/ans.14140
       
  • Intravenous lignocaine in colorectal surgery: a systematic review
    • Authors: Wiremu S. MacFater; Jamie-Lee Rahiri, Melanie Lauti, Bruce Su'a, Andrew G. Hill
      Pages: 879 - 885
      Abstract: BackgroundColorectal surgery leads to morbidity during recovery including pain and fatigue. Intravenous (IV) lignocaine (IVL) has both analgesic and anti-inflammatory effects that may improve post-operative pain and recovery. The aim of this review is to compare the effectiveness of IVL to other perioperative analgesia regimens for reducing pain and opioid consumption following colorectal surgery.MethodsUsing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, a literature search was conducted to identify randomized clinical trials that compared IVL with IV placebo or epidural anaesthesia in open or laparoscopic colorectal surgery. The primary outcomes were opioid requirements and pain scores assessed by visual analogue score. Data were entered into pre-designed electronic spreadsheets.ResultsThe literature search identified 2707 studies. A total of nine randomized clinical trials met the inclusion criteria. Five studies investigated IVL compared with IV placebo and four studies investigated IVL compared with epidural anaesthesia. Two out of the five studies comparing IVL and placebo showed statistically significant reductions in opioid consumption with IVL. There was a variable degree of improvement in pain scores when IVL was compared with epidural. Two studies showed a significant difference, with lower opioid consumption and pain scores in the epidural group. Laparoscopic and open procedures could not be compared between the IVL and placebo group.ConclusionIVL has shown limited benefit towards reducing early pain and morphine consumption when compared with placebo in colorectal surgery. However, IVL did not show any significant reduction in pain or opioid consumption when compared with epidural. Further research investigating IVL combined with intraperitoneal local anaesthetic is warranted.
      PubDate: 2017-07-05T05:20:29.597601-05:
      DOI: 10.1111/ans.14084
       
  • Out-of-office hours’ elective surgical intensive care admissions and
           their associated complications
    • Authors: David J. R. Morgan; Kwok Ming Ho, Yang Jian Ong, Marlene L. Kolybaba
      Pages: 886 - 892
      Abstract: BackgroundThe ‘weekend’ effect is a controversial theory that links reduced staffing levels, staffing seniority and supportive services at hospitals during ‘out-of-office hours’ time periods with worsening patient outcomes. It is uncertain whether admitting elective surgery patients to intensive care units (ICU) during ‘out-of-office hours’ time periods mitigates this affect through higher staffing ratios and seniority.MethodsOver a 3-year period in Western Australia's largest private hospital, this retrospective nested-cohort study compared all elective surgical patients admitted to the ICU based on whether their admission occurred ‘in-office hours’ (Monday–Friday 08.00–18.00 hours) or ‘out-of-office hours’ (all other times). The main outcomes were surgical complications using the Dindo-Clavien classification and length-of-stay data.ResultsOf the total 4363 ICU admissions, 3584 ICU admissions were planned following elective surgery resulting in 2515 (70.2%) in-office hours and 1069 (29.8%) out-of-office hours elective ICU surgical admissions. Out-of-office hours ICU admissions following elective surgery were associated with an increased risk of infection (P = 0.029), blood transfusion (P = 0.020), total parental nutrition (P < 0.001) and unplanned re-operations (P = 0.027). Out-of-office hours ICU admissions were also associated with an increased hospital length-of-stay, with (1.74 days longer, P < 0.0001) and without (2.8 days longer, P < 0.001) adjusting for severity of acute and chronic illnesses and inter-hospital transfers (12.3 versus 9.8%, P = 0.024). Hospital mortality (1.2 versus 0.7%, P = 0.111) was low and similar between both groups.ConclusionOut-of-office hours ICU admissions following elective surgery is common and associated with serious post-operative complications culminating in significantly longer hospital length-of-stays and greater transfers with important patient and health economic implications.
      PubDate: 2017-06-12T19:20:48.363357-05:
      DOI: 10.1111/ans.14027
       
  • The Perth Emergency Laparotomy Audit
    • Authors: Katherine J. Broughton; Oscar Aldridge, Sharin Pradhan, R. James Aitken
      Pages: 893 - 897
      Abstract: BackgroundEmergency laparotomies (ELs) are associated with high mortality and substantial outcome variation. There is no prospective Australian data on ELs. The aim of this study was to audit outcome after ELs in Western Australia.MethodsA 12-week prospective audit was completed in 10 hospitals. Data collected included patient demographics, the clinical pathway, preoperative risk assessment and outcomes including 30-day mortality and length of stay.ResultsData were recorded for 198 (76.2%) of 260 patients. The 30-day mortality was 6.5% (17/260) in participating hospitals, and 5.4% (19 of 354) across Western Australia. There was minimal variation between the three tertiary hospitals undertaking 220 of 354 (62.1%) ELs. The median and mean post-operative lengths of stay, excluding patients who died, were 8 and 10 days, respectively. In the 48 patients with a prospectively documented risk of ≥10%, both a consultant surgeon and anaesthetist were present for 68.8%, 62.8% were admitted to critical care and 45.8% commenced surgery within 2 h. The mortality in those retrospectively (62; 31%) and prospectively risk-assessed was 9.5% and 5.2%, respectively.ConclusionThis prospective EL audit demonstrated low 30-day mortality with little inter-hospital variation. Individual hospitals have scope to improve their standards of care. The importance of prospective risk assessment is clear.
      PubDate: 2017-08-23T22:11:10.136662-05:
      DOI: 10.1111/ans.14208
       
  • Is it right to ignore learning-curve patients' Laparoscopic colorectal
           trials
    • Authors: Alan P. Meagher; Shi Yang, Shuyuan Li
      Pages: 898 - 902
      Abstract: BackgroundIncreasingly complex, technically demanding surgical procedures utilizing emerging technologies have developed over recent decades and are recognized as having long ‘learning curves’. This raises significant new issues. Ethically and scientifically, the outcome of a patient in the learning curve is as important as the outcome of a patient outside the learning curve. The aim of this study is to highlight just one aspect of our approach to learning-curve patients that should change.MethodsThe protocols of multicentre, prospective, randomized trials of patients undergoing either traditional open or laparoscopic surgery for colorectal cancer were reviewed. The number of patients excluded from the published trial results because they were in surgeons’ learning curves was calculated. The seven editorials accompanying these publications were also examined for any mention of these patients.ResultsThe eight studies identified had similar designs. All patients in the surgeons’ laparoscopic learning curves, which were often several years long, were excluded from the actual trials. The total number of patients included in the trial publications was 5680. The number of patients excluded because they were in the surgeons’ laparoscopic learning curves was>10 605. In none of the studies or accompanying editorials is there any mention of the total number of patients in the surgeons’ learning curves, these patients’ outcomes or how inclusion of their outcomes might have affected the overall results.ConclusionLearning curves are inescapable in modern medicine. Our recognition of patients in these curves should evolve, with more data about them included in trial publications.
      PubDate: 2017-06-22T11:10:32.6641-05:00
      DOI: 10.1111/ans.14070
       
  • Unusual case of ventral liver herniation
    • Authors: Shaveen D. Kanakaratne; Gayatri Asokan, Chandika Liyanage
      Pages: 950 - 951
      PubDate: 2017-06-30T01:50:50.827197-05:
      DOI: 10.1111/ans.14082
       
  • Unusual bony hernia
    • Authors: Ramin Kousary; Hajir Nabi
      Pages: 952 - 952
      PubDate: 2017-11-02T19:03:09.134351-05:
      DOI: 10.1111/ans.14035
       
  • Non-incisional traumatic lateral abdominal wall hernia
    • Authors: Vipul D. Yagnik; Vismit Joshipura
      Pages: 952 - 953
      PubDate: 2017-11-02T19:03:05.990469-05:
      DOI: 10.1111/ans.14052
       
  • Hybrid transanal and laparoscopic hand-assisted total mesorectal excision
           for low rectal cancer
    • Authors: Narimantas E. Samalavicius; Dulskas Audrius, Aliukonis Vygintas, Rackauskas Rokas, Kilius Alfredas
      Pages: 953 - 954
      PubDate: 2017-11-02T19:03:08.411918-05:
      DOI: 10.1111/ans.13838
       
  • Rural thoracotomy and asystolic arrests: a survivor
    • Authors: David Ferreira; Rena Ng, Jaye Yick, Robin Diebold
      Pages: 954 - 954
      PubDate: 2017-11-02T19:03:07.429102-05:
      DOI: 10.1111/ans.14196
       
  • Improving first case start times: a rural perspective
    • Authors: Erin Gee; Timothy Saunder, Scott Fletcher, Craig Quarmby, Gregory Peterson
      Pages: 955 - 956
      PubDate: 2017-11-02T19:03:03.272724-05:
      DOI: 10.1111/ans.14187
       
 
 
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