ANZ Journal of Surgery

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Table of Contents for ANZ Journal of Surgery. List of articles from both the latest and EarlyView issues.
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Utero‐cutaneous fistula following Caesarean section

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page E218-E219, May 2019.

Rare finding of a giant ischioanal lipoma

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page 604-606, May 2019.

Transcatheter embolization of a large mediastinal bronchial artery aneurysm with short neck

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page 597-599, May 2019.

Not all abdominal wall masses in women are endometriomas or desmoids; endometriosis‐associated abdominal wall cancer

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page 609-611, May 2019.

Anastomotic stricture: a complication of endoscopic choledochoduodenostomy

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page E202-E203, May 2019.

Rare cause of colitis with calcified mesenteric veins

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page 613-614, May 2019.

Accidental intra‐arterial injection of methylphenidate into the radial artery

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page E200-E201, May 2019.

Rare case of Bouveret syndrome

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page E198-E199, May 2019.

Consecutive cases of thyrolipomatosis and thymolipoma: a case report

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page 614-616, May 2019.

Adult intussusception: a rare but important clinical entity

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page 611-613, May 2019.

Ultra‐late recurrence of gastrointestinal stromal tumour: case report and literature review

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page E224-E225, May 2019.

Traumatic fracture dislocation of the thoracic spine sparing both the spinal cord and aorta

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page E212-E213, May 2019.

Protuberant heterotopic ossification following distal biceps tendon repair

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page E208-E209, May 2019.

Emergency pancreatic resection for glucagonoma associated with severe necrolytic migratory erythema

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page 599-602, May 2019.

Follow the leader: followership and its relevance for surgeons

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page 589-593, May 2019.

Management of papillary lesions without atypia of the breast diagnosed on needle biopsy

April 30, 2019 - 01:16
Background

Current surgical practice often leads to excision of all papillary lesions of the breast diagnosed on percutaneous biopsy. This study aims to identify a subset of patients with papillary lesions who may be able to avoid surgery.

Methods

Between January 2000 and December 2015, 157 cases of papillary lesions with complete surgical excision pathology results were reviewed retrospectively to compare the clinical, imaging and pathology features. Of these, 50 patients with benign papillary lesions without atypia and 19 patients with benign papillary lesions with atypia on needle biopsy were analysed to determine the rate of upgrade to malignancy after surgery.

Results

Of the 50 patients with benign papillary lesions without atypia on biopsy, two (4%) were upgraded to low grade ductal carcinoma in situ after surgical excision. Both these patients had suspicious features on imaging. Of the 19 patients with papillary lesions with atypia diagnosed on needle biopsy, eight (42%) were upgraded to malignancy after surgery. The differences between benign, atypical and malignant papillary lesions were further compared. Malignant lesions were more suspicious radiologically (P = 0.001), more likely to have architectural distortion (P = 0.001), more peripherally located (P = 0.001) and were larger in size (P = 0.01). Patients diagnosed with malignant lesions were also older (P = 0.001).

Conclusion

Younger patients diagnosed with small central benign papillary lesions without atypia on needle biopsy, and without suspicious imaging, may be managed conservatively with surveillance.

Surgical ultrasonography at the bedside: a comparison of surgical trainees with trained sonographers for symptomatic cholelithiasis – a first Australian experience

April 30, 2019 - 01:16
Background

Symptomatic cholelithiasis accounts for a significant burden of emergency general surgical presentations in Australia and the Western population. Access to hepatobiliary ultrasonography to facilitate diagnosis can lead to delays in timely treatment. Surgical ultrasonography at the bedside (SUB) can mitigate this barrier to patient care. This study assessed the diagnostic accuracy of SUB by trainees versus formal ultrasonographer or computed tomography examination for suspected symptomatic cholelithiasis.

Methods

A prospective non‐inferiority study of emergency patient admissions with abdominal pain in two tertiary referral hospitals during July 2017 to October 2018 was performed. Results of SUB were compared with accredited radiographer ultrasonography or computed tomography and histopathological assessment. Positive findings at SUB for symptomatic cholelithiasis included: cholelithiasis, gallbladder wall thickness ˃3 mm, pericholecystic fluid or sonographic Murphy's sign.

Results

One hundred patients with epigastric or right upper quadrant pain underwent SUB. Mean patient age was 49 years (range 20–90 years), with 61 females and 39 males. Sensitivity and specificity for diagnosis of symptomatic cholelithiasis was 94.9% and 100% for SUB and 98.7% and 100% for accredited radiographers. Diagnostic accuracy was 96% for SUB and 99% for radiographer ultrasonography. Positive predictive value and negative predictive value were 100% and 84.6% for SUB and 100% and 96% for radiographers. The inter‐rater reliability for features compatible with the diagnosis of symptomatic cholelithiasis was good with a kappa of 0.758 (95% confidence interval 0.587–0.929, P < 0.001).

Conclusion

This first Australian experience demonstrates that general surgical trainees can accurately diagnose cholecystitis with SUB and this assessment is not inferior and has substantial agreement with accredited radiographer ultrasonography.

Cystic pheochromocytoma masquerading as a cystic pancreatic tumour

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page E195-E197, May 2019.

Collagenase injections for Dupuytren's contracture: prospective cohort study in a public health setting

April 30, 2019 - 01:16

Collagenase Clostridium histolyticum injections are a viable alternative treatment for Dupuytren's contracture in the Australian public health setting.


Background

Dupuytren's disease causes a flexion contracture of the hand that limits hand function and reduces quality of life. Traditional management is surgical excision which is associated with potentially serious complications. A viable alternative is collagenase Clostridium histolyticum (CCH) (Xiaflex®; Pfizer Australia) which is an effective, safe, outpatient treatment that to date has no published data in the Australian public health setting.

Methods

A prospective cohort, single centre study, enrolling 54 patients to treat 81 joints with CCH. Patients received a single dose to the cord followed by joint manipulation 48 h later. Primary endpoint was reduction in contracture to 0 to 5° of full extension assessed 4 weeks after injection. Secondary endpoints included range of motion, patient satisfaction and function as measured by the Southampton Dupuytren's Scoring Scheme (SDSS).

Results

Primary endpoint was achieved in 48% of joints (66% metacarpophalangeal and 19% proximal interphalangeal). Mean flexion contracture improved by 40o and 25o for metacarpophalangeal and proximal interphalangeal joints, respectively. Mean active range of motion improved by 39o and 18o, respectively. At 30 days and 12 months, SDSS score demonstrated sustained improvement versus baseline (1.88 versus 8.24 P ≤ 0.0005 and 1.59 versus 8.07 P ≤ 0.0005). Sixty‐eight percent of patients were either very satisfied or satisfied at 12‐month follow‐up. Side effects of treatment were minor; with oedema and bruising the most common (87% and 85%, respectively).

Conclusion

CCH injections are a viable treatment for Dupuytren's contracture in the Australian public health setting.

Audit and exploration of graduating medical students' opportunities to perform digital rectal examinations as part of their learning

April 30, 2019 - 01:16
ANZ Journal of Surgery, Volume 89, Issue 5, Page 617-618, May 2019.