Enormous progress has been made in the last quarter of a century in understanding the nature of root canal infection and periapical disease. New techniques and materials may be expected to increase the already high succe...Enormous progress has been made in the last quarter of a century in understanding the nature of root canal infection and periapical disease. New techniques and materials may be expected to increase the already high success of conventional root canal treatment. Surgical intervention is required for cases where retreatment has failed or is not an option, and the tooth is to be retained rather than extracted. This article reviews the operation of apicectomy and how this minor oral surgical procedure has evolved. Recent modifications to techniques and materials are likely to improve its success, allowing conservation of previously unsaveable teeth.
This presentation reviews the epidemiology of epilepsy, the evolution of epilepsy surgery, the selection of cases for surgery, the range and results of epilepsy surgery, and the future development of this burgeoning fiel...This presentation reviews the epidemiology of epilepsy, the evolution of epilepsy surgery, the selection of cases for surgery, the range and results of epilepsy surgery, and the future development of this burgeoning field. Hypothalamic hamartoma (HH) is a rare developmental lesion which causes intractable gelastic epilepsy which is refractory to medical therapy. Hypothalamic hamartoma presents a formidable surgical challenge. The application of a midline transcallosal interforniceal approach to resect the HH from within the third ventricle, in a series of 28 patients, is presented. This has produced excellent results with minimal morbidity. This surgery is placed within the context of epilepsy surgery in general.
Dijkstra B, Healy C, Kelly LM
… +3 more, McDermott EW, Hill AD, O'Higgins N
J R Coll Surg Edinb
· 2002 Aug · PMID 12365423
In patients with primary hyperparathyroidism, neck exploration by an experienced parathyroid surgeon is curative in excess of 95% of cases. Considerable efforts have been devoted to improving parathyroid imaging. New rad...In patients with primary hyperparathyroidism, neck exploration by an experienced parathyroid surgeon is curative in excess of 95% of cases. Considerable efforts have been devoted to improving parathyroid imaging. New radionucleotide agents and scanning procedures have markedly improved the success rate of localization studies with subsequent development of minimally invasive surgical techniques. In this article we review the different localization techniques and their current role in parathyroid surgery for primary hyperparathyroidism
Kanagalingam J, Georgalas C, Zainal A
… +1 more, Mochloulis G
J R Coll Surg Edinb
· 2002 Aug · PMID 12363193
We describe the use of a common radiographic view of the lower cervical skeleton, 'Swimmer's View', to aid the diagnosis of foreign bodies in the upper oesophagus, which may be obscured by the clavicles. We further recom...We describe the use of a common radiographic view of the lower cervical skeleton, 'Swimmer's View', to aid the diagnosis of foreign bodies in the upper oesophagus, which may be obscured by the clavicles. We further recommend this view when there is uncertainty over the nature of an impacted food bolus in this location, and luminal air is the only visible sign on a plain soft-tissue cervical radiograph.
Harrington P, O'Kelly A, Trail IA
… +1 more, Freemont AJ
J R Coll Surg Edinb
· 2002 Aug · PMID 12363192
Between six and eight per cent of cases of malignant melanoma lack pigmentation on macroscopic examination, making accurate early diagnosis difficult. Delays in diagnosis and misdiagnosis are common in cases of subungual...Between six and eight per cent of cases of malignant melanoma lack pigmentation on macroscopic examination, making accurate early diagnosis difficult. Delays in diagnosis and misdiagnosis are common in cases of subungual melanoma. We report a patient with an amelanotic subungual malignant melanoma who presented with a lesion that closely resembled a pyogenic granuloma. Since amelanotic melanoma usually presents as a vascular or ulcerating nodule, it should be considered in the differential diagnosis of a wide range of superficial lesions that occur in the hand.
Ghori A, Hallisey M, Nwokolo C
… +2 more, Loft D, Fraser I
J R Coll Surg Edinb
· 2002 Aug · PMID 12363191
BACKGROUND: A key step for success at endoscopic retrograde cholangio-pancreatography (ERCP) is cannulation of the sphincter of Oddi. This prospective randomised controlled study was conducted to assess the effect of gly...BACKGROUND: A key step for success at endoscopic retrograde cholangio-pancreatography (ERCP) is cannulation of the sphincter of Oddi. This prospective randomised controlled study was conducted to assess the effect of glyceryl trinitrate (GTN) on ease of cannulation. METHOD: Two hundred and fifty four patients undergoing ERCP were randomised into two groups, 126 controls and 128 pre-treated with GTN. RESULT: There were 29 cannulation failures in the whole group (overall failure rate of 11.4%). Failure was significantly less common in the GTN group, 7.03% (9/128) as compared with 15.8% (20/126) in the control group (p=0.0002). Deep cannulation was desired but not achieved in 45/200 patients (22.5%) Of these, 18.4% (19/103) were in the GTN group versus 26.8% (26/97) in the control group. This pattern of difference applied to both trained and trainee endoscopists. No significant side effects of GTN were noticed. CONCLUSION: GTN appears to be safe and effective in improving ERCP success rate. We recommend its routine use.
Pullyblank AM, Carney L, Braddon F
… +1 more, Dixon AR
J R Coll Surg Edinb
· 2002 Aug · PMID 12363190
Published evidence comparing laparoscopic and open herniorraphy is controversial. NICE recommends that open techniques are used for first time repairs and that TEP be considered for bilateral/recurrent repairs undertaken...Published evidence comparing laparoscopic and open herniorraphy is controversial. NICE recommends that open techniques are used for first time repairs and that TEP be considered for bilateral/recurrent repairs undertaken in specialist units. We report a consecutive series of 224 patients undergoing 268 TEP repairs between 1996 and 2001. Operating time, complications, return to normal activity/full time employment and recurrence were examined. The median operating time was 30 minutes. There was one conversion. Ninety four percent of patients drove on the third post-operative day. The median time to normal activity was 4 days (1-10 days). The median time to return to professional employment in 82 patients was 3 days (range 2-9 days). Four patients (1.7%) had self-limiting minor groin pain. There were 3 recurrences (1.4%) and none since altering the surgical technique to use a larger anchored mesh. We have demonstrated TEP to be an easily learnt, safe, effective technique with low morbidity, and with sufficient experience, takes no longer than an open repair. It can be performed at little increased cost and restores selected patients to an early return to full-time employment. We believe that the choice between open and laparoscopic repair is a subjective decision for patient and surgeon
BACKGROUND: Transient femoral nerve palsy (TFNP) has been reported in patients undergoing inguinal hernia repair involving the use of ilio-inguinal nerve block. Ilio-inguinal nerve blocks can be administered under vision...BACKGROUND: Transient femoral nerve palsy (TFNP) has been reported in patients undergoing inguinal hernia repair involving the use of ilio-inguinal nerve block. Ilio-inguinal nerve blocks can be administered under vision by the surgeon or by the anaesthetist using a standard blind technique. There has been no study that has specifically examined the incidence of this complication and whether its development is related to the type of method used to administer the block. PATIENTS AND METHODS: Data on patients undergoing surgery in the Royal Infirmary Edinburgh Day Case Unit are collected prospectively. All patients who undergo inguinal hernia repair are given ilio-inguinal field blocks, either pre-operatively by anaesthetists (blind technique) or peri-operatively under direct vision by surgeons. Several cases of TFNP were initially identified during the process of surgical audit and this led to a retrospective analysis over a period of one year. RESULTS: During a 12-month period, 194 patients underwent 200 open inguinal hernia repairs (188 unilateral and 6 bilateral), under general anaesthesia. Ten patients (5%) developed TFNP resulting in overnight admission. Surgeons administered 101 blocks under direct vision of which 4 (4%) resulted in TFNP, whereas 6 out of 99 (6%) blind blocks resulted in TFNP (p=0.49, df=1, Chi2 test). DISCUSSION AND CONCLUSION: TFNP is a recognised complication following ilioinguinal nerve blockade for inguinal hernia surgery. Our series shows that ilio-inguinal block given under direct vision does not appear to reduce the chance of this complication occurring. This may result from the fact that this complication could be due to local infiltration into the operative field rather than direct infiltration around the femoral nerve. As inguinal hernia repair undertaken as a day case procedure increases, the awareness of this complication is important to avoid morbidity
Perforation of the thoracic oesophagus is a serious clinical problem, associated with a high morbidity and mortality, especially if treated late. Primary repair with or without reinforcement is commonly recommended, if t...Perforation of the thoracic oesophagus is a serious clinical problem, associated with a high morbidity and mortality, especially if treated late. Primary repair with or without reinforcement is commonly recommended, if the patient presents within 24 hours. As the time to treatment increases, primary repair has a high rate of leakage and complications. A useful technique of temporary oesophageal exclusion and diversion with spontaneous recanalisation is presented. The technique obviates the need for thoracotomy and preserves the native oesophagus
Hunt V, Bulstrode C, Baldwin P
… +2 more, Bulstrode H, Mansfield C
J R Coll Surg Edinb
· 2002 Aug · PMID 12363187
A three-day course was designed to improve the skills of those who provide clinical training to medical students. This long-term follow up of past participants shows a sustained improvement to their skills, especially in...A three-day course was designed to improve the skills of those who provide clinical training to medical students. This long-term follow up of past participants shows a sustained improvement to their skills, especially in terms of involving students in their own learning, and giving them positive feedback.
Percutaneous repair of a ruptured Achilles tendon is a safe and reliable method of treating such injuries in patients with low sporting requirements. It has a lower incidence of wound complications compared with open tec...Percutaneous repair of a ruptured Achilles tendon is a safe and reliable method of treating such injuries in patients with low sporting requirements. It has a lower incidence of wound complications compared with open techniques but a slightly higher incidence of re-rupture. Sural nerve injury is avoidable by careful placement of the incisions
Since the 1970's coronary bypass surgery has evolved to become one of the commonest and most successful of all operative procedures. The symptomatic and survival benefit of this surgery is well recognised. However, devel...Since the 1970's coronary bypass surgery has evolved to become one of the commonest and most successful of all operative procedures. The symptomatic and survival benefit of this surgery is well recognised. However, developments in cardiological interventions, coupled with demographic and lifestyle changes, are altering the patient profile and referral pattern. Coronary surgery at the beginning of the new century frequently involves higher risk patients and more complex surgery as a result of changes in disease presentation and the success of competing cardiological interventional techniques for less extensive disease. Technological advances in endovascular devices are making significant inroads into traditional coronary surgical practice. Surgeons have responded by developing new strategies to maximise effectiveness of coronary surgery and minimise the injury associated with cardiopulmonary bypass. At the same time regulatory and media scrutiny is focussing attention on the cardiac surgeon, further adding to the stresses and complexity of cardiac surgical practice
DNA damage activates checkpoint pathways to produce a G1 or G2 cell cycle arrest and DNA repair. G2 checkpoint integrity prevents inappropriate mitosis of unrepaired DNA. Cell cycle progression is determined by cyclin-de...DNA damage activates checkpoint pathways to produce a G1 or G2 cell cycle arrest and DNA repair. G2 checkpoint integrity prevents inappropriate mitosis of unrepaired DNA. Cell cycle progression is determined by cyclin-dependent kinase (CDK) enzymes in association with specific cyclin proteins, with Cdc2/cyclin B regulating mitosis. The tumour suppressor p53 re-enforces G2 arrest through the CDK inhibitor, p21(WAF1/CIPI). Functional regulation of G2 checkpoint proteins occurs through levels of protein expression, phosphorylation and subcellular localisation
Five cases of oro-facial infection leading to life-threatening complications are reported. Although all had been treated with antibiotics prior to maxillofacial referral, lack of surgical intervention had allowed progres...Five cases of oro-facial infection leading to life-threatening complications are reported. Although all had been treated with antibiotics prior to maxillofacial referral, lack of surgical intervention had allowed progressive infection. The importance of resuscitation, supportive therapy, extraction of involved teeth to remove the source of infection and drainage of pus is emphasised
Anterior sacral meningoceole is a rare occurrence and presentation as a perianal abscess has not been previously reported. The case is presented and the condition discussed. The potential risks of failing to establish th...Anterior sacral meningoceole is a rare occurrence and presentation as a perianal abscess has not been previously reported. The case is presented and the condition discussed. The potential risks of failing to establish the diagnosis, prior to surgery, are outlined.
Abul S, Al-Oazweni H, Zalat S
… +2 more, Al-Sumait B, Asfar S
J R Coll Surg Edinb
· 2002 Jun · PMID 12109613
Cocoon abdomen is a rare cause of intestinal obstruction and its pathogenesis remains unclear. This is probably the first report of the development of such a condition in a liver transplant recipient. The management of t...Cocoon abdomen is a rare cause of intestinal obstruction and its pathogenesis remains unclear. This is probably the first report of the development of such a condition in a liver transplant recipient. The management of this patient is discussed and the current literature is reviewed
Throughout the twenty-two year period of the Napoleonic Wars, campaigns under extremes of climate cost the Allies much in terms of mortality and morbidity. Although Bonaparte brought about many sound political and nation...Throughout the twenty-two year period of the Napoleonic Wars, campaigns under extremes of climate cost the Allies much in terms of mortality and morbidity. Although Bonaparte brought about many sound political and national improvements, when France had been brought to its knees by the bloody Revolution, his ambitions became excessive and his military forays difficult to support. Following early successes in the field, he underestimated the determination, persistence and the ability of some opposing commanders. The French medical services profited greatly from the innovations of the post-revolutionary period, and the efforts of men such as Larrey and Percy. The British Army medical support was scanty, and, initially lacked experience. To some extent, this latter defect was corrected by Sir James McGrigor during the Peninsular War. Each campaign brought it's own perils and most men died of deprivation, disease and effects of climate, rather than battle injury. There were technically able surgeons who were inevitably hampered by lack of antiseptic technique, anaesthesia and the lack of understanding of the fundamental aspects of hygiene, adequate diet and good nursing care.
Kumar A, Doran J, Batt ME
… +2 more, Nguyen-Van-Tam JS, Beckingham IJ
J R Coll Surg Edinb
· 2002 Jun · PMID 12109611
AIMS: To evaluate the role of surgical exploration and repair of the inguinal canal in athletes suspected of having a sports hernia. METHODS: Thirty-five (34 males, 1 female) athletes with a suspected sports hernia under...AIMS: To evaluate the role of surgical exploration and repair of the inguinal canal in athletes suspected of having a sports hernia. METHODS: Thirty-five (34 males, 1 female) athletes with a suspected sports hernia underwent surgical exploration and inguinal hernia repair. After six months, all athletes were sent questionnaires to assess any improvement in analogue pain scores, return to sport, recurrence of symptoms and the overall result of surgery. RESULTS: Operative findings revealed a tear in the external oblique aponeurosis with or without a significant posterior bulge (n=20), a lone significant posterior bulge (n=10), a tear in the conjoint tendon with dilated superficial ring (n=3), small direct hernial sac (n=1) and lipoma of the spermatic cord (n=1). Surgery consisted of repair of external oblique tear (when present) and prolene darn or lichtenstein mesh repair of the posterior inguinal canal. Twenty-seven patients replied to the questionnaire giving a response rate of 78%; of these, 25 patients (93%: 95% CI 83-100) had returned to normal athletic activities at pre-injury level. There was a marked improvement in level of pain (median pain level=8 pre-operative vs 2 post-operative, p<0.001). Eleven patients (41%) rated the results as excellent, eleven (41%) as good and five (18%) as fair and none worse. Six patients complained of occasional discomfort related to the scar. Three patients complained of recurrence of their symptoms after 4 to 5 months following strenuous exercise. CONCLUSION: Sports hernia presents with a spectrum of surgical findings. Athletes with sports hernia should be considered for routine hernia repair, as the majority of the patients benefit from surgery. It is important to offer a structured rehabilitation programme to maximise the benefits of surgery.
Jansen JO, O'Kelly TJ, Krukowski ZH
… +1 more, Keenan RA
J R Coll Surg Edinb
· 2002 Jun · PMID 12109610
BACKGROUND: Mechanical bowel preparation before colonic surgery is widely advocated but remains controversial. Recent guidelines published by the Clinical Standards Board for Scotland recommend mechanical bowel preparati...BACKGROUND: Mechanical bowel preparation before colonic surgery is widely advocated but remains controversial. Recent guidelines published by the Clinical Standards Board for Scotland recommend mechanical bowel preparation prior to surgery for all colorectal cancers but this may be inappropriate. This study examines the outcome of a policy of no mechanical preparation before elective right hemicolectomy. METHOD: Data on 102 consecutive patients undergoing elective right or extended right hemicolectomy for colonic adenocarcinoma were extracted from a prospective database. RESULTS: No clinical anastomotic leaks were observed. Two patients developed wound infections and one patient died with no autopsy evidence of anastomotic leak. CONCLUSION: Mechanical bowel preparation can safely be omitted prior to right hemicolectomy in patients with colonic cancer.