25, 50 and 75 years ago

Cameron P, Civil I. The management of anterior abdominal stab wounds in Australasia. ANZ. J. Surg. 1998; 68:510–3. The low incidence of stab wounds in Australasia has led to a more operative approach for the management of anterior abdominal stab wounds. A survey of Australasian surgeons interested in trauma was undertaken to analyse current practice. Ninety-seven early management of severe trauma surgical instructors (known as ATLSB in Australasia) were surveyed using a four-part, singlepage questionnaire. Sixty-five instructors completed the survey. Thirty-nine instructors stated that they would admit patients with stab wounds even if the wound appeared superficial or ‘skin only’. For 14 surgeons, the decision to perform a laparotomy was dependent on fascial penetration and for 17 the decision depended upon peritoneal penetration. Six felt that all but the most superficial wounds should have a laparotomy. Laparoscopy, diagnostic peritoneal lavage and other investigations were also thought to be helpful. Thirteen surgeons felt that the presence of peritonism or tenderness were the most important determinants. There was no hospital protocol for 44 respondents and there was a wide variation in individual approach to this problem. However, all agreed that peritonism and haemodynamic instability were indications for immediate laparotomy. There is still a low threshold for laparotomy in Australasia and this approach is not without risks. However, the alternative of using serial observation should be regarded as an active form of management and protocols must be established to ensure regular repeat examinations by experienced personnel. The low incidence of abdominal stab wounds in Australasia makes this approach difficult. A safe approach for the Australasian situation is described. Civil IDS, King M, Paice R. Penetrating trauma in Auckland: 12 years on. ANZ J. Surg. 1998; 68:261–3. The current spectrum of penetrating trauma presenting to Auckland Hospital is described and whether this differs from the situation in 1983 is determined. Prospectively collected trauma registry data were used to describe the characteristics of penetrating trauma cases presenting to Auckland Hospital during the 1995 calendar year. Using data collected from a previous study in 1983, comparisons were made of the incidence, severity, and outcome of penetrating trauma cases between these two cohorts. In 1995, 96 patients, representing 7.3% of total trauma admissions, presented to Auckland Hospital following penetrating trauma. Of these, 32 patients were admitted by the trauma team via the resuscitation room, 13 were admitted to the intensive care unit (ICU) and four died. The median age of these patients was 30 years and median Injury Severity Score, 4. In comparison with the 1983 patients, there was no demonstrable change in the numbers of patients or their length of stay. Although injury severity was similar in the 1995 cohort, fewer patients were admitted to the ICU. Mortality of the ‘trauma team’ group was 4/32 in 1995 compared with 7/33 in 1983. Despite public concerns, the frequency of penetrating trauma cases presenting to Auckland Hospital was similar in 1995 and 1983. There is a non-significant decrease in length of stay and mortality in the 1995 cohort.

stab wounds in Australasia.ANZ.J. Surg. 1998;68:510-3.The low incidence of stab wounds in Australasia has led to a more operative approach for the management of anterior abdominal stab wounds.A survey of Australasian surgeons interested in trauma was undertaken to analyse current practice.Ninety-seven early management of severe trauma surgical instructors (known as ATLSB in Australasia) were surveyed using a four-part, singlepage questionnaire.Sixty-five instructors completed the survey.Thirty-nine instructors stated that they would admit patients with stab wounds even if the wound appeared superficial or 'skin only'.For 14 surgeons, the decision to perform a laparotomy was dependent on fascial penetration and for 17 the decision depended upon peritoneal penetration.Six felt that all but the most superficial wounds should have a laparotomy.Laparoscopy, diagnostic peritoneal lavage and other investigations were also thought to be helpful.Thirteen surgeons felt that the presence of peritonism or tenderness were the most important determinants.There was no hospital protocol for 44 respondents and there was a wide variation in individual approach to this problem.However, all agreed that peritonism and haemodynamic instability were indications for immediate laparotomy.There is still a low threshold for laparotomy in Australasia and this approach is not without risks.However, the alternative of using serial observation should be regarded as an active form of management and protocols must be established to ensure regular repeat examinations by experienced personnel.The low incidence of abdominal stab wounds in Australasia makes this approach difficult.A safe approach for the Australasian situation is described.
The current spectrum of penetrating trauma presenting to Auckland Hospital is described and whether this differs from the situation in 1983 is determined.Prospectively collected trauma registry data were used to describe the characteristics of penetrating trauma cases presenting to Auckland Hospital during the 1995 calendar year.Using data collected from a previous study in 1983, comparisons were made of the incidence, severity, and outcome of penetrating trauma cases between these two cohorts.In 1995, 96 patients, representing 7.3% of total trauma admissions, presented to Auckland Hospital following penetrating trauma.Of these, 32 patients were admitted by the trauma team via the resuscitation room, 13 were admitted to the intensive care unit (ICU) and four died.The median age of these patients was 30 years and median Injury Severity Score, 4. In comparison with the 1983 patients, there was no demonstrable change in the numbers of patients or their length of stay.Although injury severity was similar in the 1995 cohort, fewer patients were admitted to the ICU.Mortality of the 'trauma team' group was 4/32 in 1995 compared with 7/33 in 1983.Despite public concerns, the frequency of penetrating trauma cases presenting to Auckland Hospital was similar in 1995 and 1983.There is a non-significant decrease in length of stay and mortality in the 1995 cohort.

Fifty years ago
Sandeman T. The roles of radiotherapy and cytotoxic drugs in the management of carcinoma of the oesophagus.ANZ J. Surg. 1973;42:373-6.
Cancer of the oesophagus is a most disappointing disease to manage.The public hospital experience in Victoria over the decade 1960-1969 was uniformly bleak, in that only 15 patients survived 5 years out of a total of 500 registered with the Anti-Cancer Council of Victoria.No 10-year survivors were seen.Only a few fortunate exceptions derived any benefit from any attempted therapy in a sample survey of the clinical material at the Peter MacCallum Clinic.However, there is an increasing awareness of the possibilities of relief in cases suitable for radical X-ray therapy, thanks to the publications of Pearson and Nakayama.Cytotoxic therapy has not been tried adequately, but it has so far failed in this situation to be of much use at all.Suggestions are made as to possible improvements in a combined attack on the lesion.
Nicks R, Green D, McClatchie G.A clinic-pathological study of some factors influencing survival in cancer of the oesophagus: a survey of ten years' experience.ANZ J. Surg. 1973;43:3-13.
In summary: (1) Carcinoma of the oesophagus, irrespective of its type or site, is usually a mortal disease which presents at a late stage, by which time all current forms of treatment are largely palliative.
(2) Resection if practicable after suitable preparation, including intensive radiotherapy, is the best form of palliation and gives some chance of cure.
(3) En-bloc excision of the carcinoma at least five centimetres beyond the visible carcinoma edge at either end and including mediastinal tissues is recommended.(4) Mobilization of the duodenum and preservation of the cardia permit high anastomosis in the upper part of the right side of the thorax or in the neck.Jejunal interposition, or a Roux-en-y reconstruction, is satisfactory when the stomach is involved.(5) The results of radiotherapy alone have been disappointing.

Seventy-five years ago
Leslie D. Some observations on the early management of gunshot wounds of the arteries.ANZ J. Surg. 1948;18:163-71.
The management of certain clinical problems presented by gunshot wounds of the larger arteries was discussed from the point of view of the field surgeon, who sees all the cases, including those early failures in patients who die or lose their limbs and therefore never reach a special vascular centre.Observations under these conditions are.however, hampered by a lack of special facilities and equipment and by the difficulty of long-term follow-up.
In summary: (1) There is clinical evidence that vascular spasm after gunshot injury is similar to that following any other injury, and can impede the distal circulation by affecting the collaterals.
(2) Such spasm can sometimes be relieved by local treatment of the vascular injury.
(3) If there is an incomplete lesion of an artery it must be explored and dealt with by double ligature and division.This carries more hope for the distal circulation than does conservative treatment.(4) The bleeding buttock wound is the only condition in which proximal ligation at a distance is advisable in the treatment of haemorrhage.