Fixation of small articular fragments in intra-articular fractures may be difficult and best results are achieved with restoration of anatomical position. A simple technique is described for ensuring good reduction and s...Fixation of small articular fragments in intra-articular fractures may be difficult and best results are achieved with restoration of anatomical position. A simple technique is described for ensuring good reduction and stabilisation of such articular fragments.
Chordoma is a rare, slow-growing, but locally aggressive malignant tumour derived from the primitive notochord. Pilonidal sinus disease, characterised by communicating granulating natal cleft tracts and abscesses, is a c...Chordoma is a rare, slow-growing, but locally aggressive malignant tumour derived from the primitive notochord. Pilonidal sinus disease, characterised by communicating granulating natal cleft tracts and abscesses, is a common condition. We report a case of a sacro-coccygeal chordoma diagnosed incidentally on surgical exploration of a case of presumed pilonidal disease.
Spontaneous rupture of the inferior vena cava is a rare clinical entity. Diagnosis of this condition, in the absence of any relevant history, is usually made at laparotomy. Only one such case has previously been reported...Spontaneous rupture of the inferior vena cava is a rare clinical entity. Diagnosis of this condition, in the absence of any relevant history, is usually made at laparotomy. Only one such case has previously been reported in the literature. We report a case of spontaneous rupture of the inferior vena cava which was diagnosed following laparotomy for hypovolaemia and acute abdominal pain. This case highlights the fact that spontaneous rupture of the inferior vena cava may be a cause of massive intra-abdominal bleeding not associated with trauma or rupture of the abdominal aorta.
The place of a D2 gastrectomy for dealing with an antral stomach cancer inpatients in the West is a matter of continuing debate. This article describes a standardised operative procedure with the aim of achieving a satis...The place of a D2 gastrectomy for dealing with an antral stomach cancer inpatients in the West is a matter of continuing debate. This article describes a standardised operative procedure with the aim of achieving a satisfactory clearance of the gastric cancer in the antrum and a systematic removal of the regional draining lymphatics.
The passage of oxygen from the atmosphere to the mitochondria is a complex process. Pathological conditions may affect this transfer at any step. The patient on the intensive care unit is particularly likely to be affect...The passage of oxygen from the atmosphere to the mitochondria is a complex process. Pathological conditions may affect this transfer at any step. The patient on the intensive care unit is particularly likely to be affected by disease or iatrogenic intervention. Hypoxia may be caused by an abnormal supply of oxygen, abnormalities of gas exchange, deficient transport in the blood or alterations in localized tissue utilization. An understanding of the principles involved will enable effective interpretation and subsequent management of the hypoxic patient.
Slater N, Singh R, Senasinghe N
… +3 more, Gore R, Goroszeniuk T, James D
J R Coll Surg Edinb
· 2000 Aug · PMID 11130022
Pressure changes around the femoral nerve were monitored throughout 10 consecutive primary total hip replacements to identify any surgical steps that might raise pressure around the nerve and be implicated in iatropathic...Pressure changes around the femoral nerve were monitored throughout 10 consecutive primary total hip replacements to identify any surgical steps that might raise pressure around the nerve and be implicated in iatropathic palsy. The only notable variable was the patient himself/herself. The only step that consistently raised pressure around the nerve, sometimes to alarming levels, was use of a retractor sited on the anterior lip of the acetabulum. Pressure changes were modest in patients with an endomorphic body type suggesting relative protection from this injury by a thicker soft cushion.
OBJECTIVES: A temporary elevation in serum-prostate specific antigen (PSA) levels has been reported in association with acute urinary retention. In spite of this, it is not uncommon for clinicians to assay PSA at the tim...OBJECTIVES: A temporary elevation in serum-prostate specific antigen (PSA) levels has been reported in association with acute urinary retention. In spite of this, it is not uncommon for clinicians to assay PSA at the time a patient presents with acute urinary retention. We sought to evaluate whether this practice can be justified. PATIENTS AND METHOD: Fifty-four patients, aged between 55 and 89 years, who presented to a single institution with acute urinary retention were studied. A PSA assay was performed on admission and a record made of the prostatic size as assessed by digital rectal examination. All patients underwent a trial without catheter, those that failed to void underwent prostatic surgery whilst all others were followed up as outpatients. RESULTS: Five patients were found to have prostatic carcinoma, three following transurethral resection of the prostate (TURP) and two following needle biopsy, performed because of persistent elevation of the PSA. A significant elevation in the PSA was associated with acute urinary retention, with only 15 (28%) patients having a PSA of 4.0 ng/ml or less. This elevation reduced the sensitivity of PSA in detecting carcinoma of the prostate; even with a cut-off of 20 ng/ml, the positive predictive value of the test was only 21%. CONCLUSIONS: A PSA assay should not be performed at the time of presentation with acute urinary retention as it may lead to unnecessary investigations and anxiety for the patient. For those in whom a PSA assay is desirable a delay of 2 weeks should be allowed prior to sampling, as the half-life of PSA is known to be 2-3 days.
Graham CA, O'Toole SJ, Watson AJ
… +2 more, Munro FD, Haddock G
J R Coll Surg Edinb
· 2000 Aug · PMID 11130020
BACKGROUND: Trauma is the leading cause of death in children. Abdominal trauma is common, but there is little information on pancreatic injuries in UK children. The aim of this study was to investigate the clinical cours...BACKGROUND: Trauma is the leading cause of death in children. Abdominal trauma is common, but there is little information on pancreatic injuries in UK children. The aim of this study was to investigate the clinical course of children suffering pancreatic trauma in Scotland. METHODS: All children admitted to the three major Scottish paediatric surgery centres with evidence of pancreatic injury were identified. A retrospective case note review of these children was performed using a structured proforma. RESULTS: 16 patients (11 males and 5 females), median age 7 years (range 1-11 years) were identified. The commonest mechanism of injury was the typical bicycle handlebar injury (10/16, 62%). Delays in definitive diagnosis were common due to subtle clinical signs. Increased serum amylase levels upon admission were not necessarily diagnostic for pancreatic injury. The diagnosis was confirmed by ultrasound scanning and/or computerised tomography in all patients. Ten patients (62%) developed pseudocysts and, in seven cases, they settled with non-operative management. There were no deaths and no long-term complications. CONCLUSION: Pancreatic injury in children is rare, and a high index of suspicion is required to make the diagnosis. The commonest mechanism of injury is a direct impact to the epigastrium, typically the bicycle handlebar injury. Presentation and diagnosis are frequently delayed. The incidence of pseudocysts is high, but most can be managed conservatively.
A series of 53 closed tibial fractures were treated with interlocking intramedullary nailing. Excluding the routine postoperative radiographs at the time of surgery, a median number of seven radiographs were taken per pa...A series of 53 closed tibial fractures were treated with interlocking intramedullary nailing. Excluding the routine postoperative radiographs at the time of surgery, a median number of seven radiographs were taken per patient (range 2-13). In total, 343 radiographs were taken after the postoperative film. Of these 343 radiographs, only nine (3%) radiographs led to a decision for clinical intervention. No radiograph in the first 10 weeks after surgery changed management. A reduction in the use of post-operative radiography after tibial nailing is recommended.
Apoptosis is the biological process by which cells in tissues undergo programmed death. This process is morphologically identifiable and characterised by light and electron microscopy. However, the biological mechanisms...Apoptosis is the biological process by which cells in tissues undergo programmed death. This process is morphologically identifiable and characterised by light and electron microscopy. However, the biological mechanisms underlying this process, as yet, are poorly understood and in need of elucidation. As apoptotic tumour cells can be identified and counted by light microscopy, there has been interest in the application of the enumeration of apoptosis in malignant growths as a putative prognostic marker. This review outlines the rationale for and discusses the relevance of using such an approach in clinical practice.
Khairy GE, al-Saigh A, Trincano NS
… +2 more, al-Smayer S, al-Damegh S
J R Coll Surg Edinb
· 2000 Oct · PMID 11077786
High output external duodenal fistula is a difficult condition to treat and despite the advances in nutritional care, morbidity and mortality remain high. Although, non surgical methods (e.g. endoscopy, fistuloscopy and...High output external duodenal fistula is a difficult condition to treat and despite the advances in nutritional care, morbidity and mortality remain high. Although, non surgical methods (e.g. endoscopy, fistuloscopy and percutaneous injection of substances) have been reported sporadically in the treatment of enterocutaneous fistulae, gelfoam has not been tried. We present a case of duodenal fistula following blunt abdominal trauma which persisted for 14 weeks on conservative management. Percutaneous obliteration of the duodenal fistula was successfully performed using gelfoam injection through a catheter. This procedure is simple, safe and cheap and further experience may demonstrate that it is an easy and more practical tool in dealing with this problem.
A rapidly enlarging lump in the neck of an adolescent, is a cause for concern. Amongst the various clinical differential diagnoses, including lymphoma and other malignant lesions, focal myositis is an unusual cause. To d...A rapidly enlarging lump in the neck of an adolescent, is a cause for concern. Amongst the various clinical differential diagnoses, including lymphoma and other malignant lesions, focal myositis is an unusual cause. To date, only two such cases affecting the sternomastoid have been reported worldwide. We report a further similar case.
A 21-month-old male child presented with malnutrition and painless abdominal masses. The masses were provisionally diagnosed as being abdominal lymphoma. Pre-operative investigations did not establish any other cause. Th...A 21-month-old male child presented with malnutrition and painless abdominal masses. The masses were provisionally diagnosed as being abdominal lymphoma. Pre-operative investigations did not establish any other cause. The diagnosis of primary gastrointestinal aspergilloma was obtained only post-operatively by histopathology and tissue culture. Following surgery, the tumour grew rapidly and massively despite intravenous amphotericin-B, in the recommended doses. The tumour caused recurrent intestinal obstruction which necessitated multiple extensive surgical excisions. The patient finally died due to sepsis and gastrointestinal bleeding. We believe this to be the first description of a primary gastrointestinal aspergilloma with aggressive local infiltration in a non-neutropenic child.
The precise cause of Bell's palsy remains unclear. A variety of mechanisms have been linked to this palsy, including viral re-activation, demyelination, oedema, vasopasm and trauma. A link with dental treatment has been...The precise cause of Bell's palsy remains unclear. A variety of mechanisms have been linked to this palsy, including viral re-activation, demyelination, oedema, vasopasm and trauma. A link with dental treatment has been suggested previously, and a series of seven cases of facial nerve palsy following intra-oral surgery are reported. All of the patients had local anaesthetic solution containing adrenaline as the vasoconstrictor administered. There may be under-reporting of this association, as patients with facial nerve palsy are treated by specialists from several disciplines, not only maxillofacial surgeons. An association with local anaesthesia administered to permit dental treatment would have important medicolegal consequences, and perhaps go some way to explaining the pathophysiology of Bell's palsy.
Wiskott-Aldrich syndrome (WAS) is a rare, generally X-linked recessive condition, originally described by Wiskott in 1937 as a triad of discharging ears, eczema and thrombocytopoenia. Aldrich included bloody diarrhoea in...Wiskott-Aldrich syndrome (WAS) is a rare, generally X-linked recessive condition, originally described by Wiskott in 1937 as a triad of discharging ears, eczema and thrombocytopoenia. Aldrich included bloody diarrhoea in his report of 1954, with severe immunodeficiency and predisposition to malignancy being recognised subsequently. The incidence currently quoted is approximately 4 per million live male births, although there is some regional variation. We report the case of a long-term survivor who had massive haemorrhage from an intrahepatic aneurysm and, on a separate occasion, the right kidney.
A prospective audit of 5430 initial consultations and 1602 admissions to Scottish hospitals for surgical treatment of otitis media with effusion in childhood in ear, nose and throat departments throughout Scotland has be...A prospective audit of 5430 initial consultations and 1602 admissions to Scottish hospitals for surgical treatment of otitis media with effusion in childhood in ear, nose and throat departments throughout Scotland has been carried out. The results suggest that Scottish children are assessed by clinicians of appropriate experience when initially seen in outpatients and only a minority (30%) are listed for surgery following their first visit. Not all children have a hearing test at their initial clinic visit. In those cases where surgical treatment is not advised at the first visit, a policy of "watchful waiting" is preferred to medical treatment by most clinicians. Bilateral dry tap rates varied between zero in Forth Valley and 19% in Lanarkshire. Fifty one per cent of operations were carried out by consultants and only 3% by SHOs. "Best practice" for the initial management of childhood ear problems is widespread in Scotland but there is room for improvement. There is a need for review of the availability of paediatric audiology services.
We report the design of a surgical instrument that facilitates the harvest of the autologous patellar tendon in anterior cruciate ligament (ACL) reconstruction. The advantage of this jig is that it is a simple, self-cent...We report the design of a surgical instrument that facilitates the harvest of the autologous patellar tendon in anterior cruciate ligament (ACL) reconstruction. The advantage of this jig is that it is a simple, self-centring device resulting in a reproducible and consistent autograft. Its use also minimises the potential risks of donor site morbidity such as patellar fracture and tendon rupture. We briefly describe our technique and discuss its advantages.