Journal Of The Royal College Of Surgeons Of Edinburgh[JOURNAL]
Sun
200 papers
Painless limp as a presentation of pelvic eosinophilic granuloma in a child.
Patil S, Kurdy NM
J R Coll Surg Edinb · 2002 Feb · PMID 11878302
Painless limp in children continues to pose a diagnostic challenge. In the majority of the cases transient synovitis of the hip is the cause. However, bone tumours should be considered as a possibility and specifically l...
Painless limp in children continues to pose a diagnostic challenge. In the majority of the cases transient synovitis of the hip is the cause. However, bone tumours should be considered as a possibility and specifically looked for when a child continues to have ongoing symptoms. Failure to diagnose tumours at an early stage can lead to a poorer outcome. This case report describes a child with eosinophilic granuloma who presented with a progressive painless limp. It emphasises the need to look carefully at the pelvic bones when evaluating a hip radiograph.
Biliary surgery in sickle cell disease: the Jamaican experience.
Duncan ND, Smith AI, McDonald AH … +1 more , Mitchell DI
J R Coll Surg Edinb · 2002 Feb · PMID 11878301
Of 62 patients with homozygous sickle cell disease subjected to open cholecystectomy for symptomatic gallstones over a 12-year period at the University Hospital of the West Indies, 25 were males and 37 were females. Of t...
Of 62 patients with homozygous sickle cell disease subjected to open cholecystectomy for symptomatic gallstones over a 12-year period at the University Hospital of the West Indies, 25 were males and 37 were females. Of these, 27 were paediatric patients aged 18 years or less, and 35 were adults. Preoperative transfusion was selectively administered. All cases presented with right upper quadrant pain and 15 of 62 with obstructive jaundice. Mucocoele of the gallbladder, empyema of the gallbladder and common bile duct stones were detected in 2, 2, and 23 patients, respectively. Exploration of the common bile duct was necessary in 31 cases and a T-tube sited in 15 cases. Twelve of the 62 patients developed acute chest syndrome post operatively (20%). There were 2 deaths, both occurring in patients who had developed acute chest syndrome; in a 34 year old and a 10 year old patient. Common bile duct related morbidity was proportionately more common in paediatric patients than adults, represented by ductal dilation (48% vs 37%), ductal calculi (44% vs 31%) and retained stones (7% vs 3%).
Preliminary results of using a commercial fibrin sealant in the treatment of fistula-in-ano.
Chan KM, Lau CW, Lai KK … +4 more , Auyeung MC, Ho LS, Luk HT, Lo KH
J R Coll Surg Edinb · 2002 Feb · PMID 11878300
A prospective non-randomised study fibrin sealant injection to manage patients with fistula-in-ano, with magnetic resonance imaging (MRI) monitoring, was performed during the period 5/6/1999 to 28/2/2000. The aim was to...
A prospective non-randomised study fibrin sealant injection to manage patients with fistula-in-ano, with magnetic resonance imaging (MRI) monitoring, was performed during the period 5/6/1999 to 28/2/2000. The aim was to determine whether a fibrin sealant could be used as a treatment modality for anorectal fistula and the usefulness of MRI perineum to monitor the disease activity. Ten patients were included in the study. Mean age was 47 years (range 7 months to 70 years). Male: female ratio was 9:1. Mean follow-up duration was 26.4 weeks. The overall success rate was 60%. The success rate of different fistula types were different (60%, 0%, 100% for intersphincteric, transphincteric, subcutaneous, respectively). Variable decrease in signal on STIR images and contrast enhancement was noted in the patients with successful and failure of fibrin sealant injection. In conclusion, fibrin sealant injection is a useful alternative treatment in the management of fistula-in-ano. MRI is helpful in delineating the anatomy of fistula-in-ano but not a useful tool to follow-up disease activity.
Atraumatic rupture of the spleen in adults.
Debnath D, Valerio D
J R Coll Surg Edinb · 2002 Feb · PMID 11874265
Atraumatic rupture of the spleen is an uncommon but important clinical entity. Unfortunately, the diagnosis is often missed due to the absence of any history of trauma. Various aspects of atraumatic rupture of the spleen...
Atraumatic rupture of the spleen is an uncommon but important clinical entity. Unfortunately, the diagnosis is often missed due to the absence of any history of trauma. Various aspects of atraumatic rupture of the spleen, including those of 'pathologic' and 'spontaneous' rupture of the spleen, have been reviewed. Increased awareness of this condition would enhance early diagnosis and effective treatment. Further research is required to identify the possible risk factors associated with spontaneous rupture of the spleen.
Endoscopic anterior cruciate ligament reconstruction using a four strand hamstring tendon construct.
Deehan DJ, Pinczewski LA
J R Coll Surg Edinb · 2002 Feb · PMID 11874264
Disruption of the anterior cruciate ligament (ACL) may result in recurrent episodes of giving way of the knee with the risk of concomitant damage to the menisci and chondral surfaces. Surgical reconstruction for ACL liga...
Disruption of the anterior cruciate ligament (ACL) may result in recurrent episodes of giving way of the knee with the risk of concomitant damage to the menisci and chondral surfaces. Surgical reconstruction for ACL ligament deficiency is aimed at restoring normal knee kinematics, thereby, allowing for return to pre-injury function. Endoscopic reconstruction of the ACL using a four-strand tendon autograft is a well documented, prospectively evaluated methodology. This article outlines the authors' technique and identifies key points of the surgical procedure.
Haematuria investigation based on a standard protocol: emphasis on the diagnosis of urological malignancy.
Alishahi S, Byrne D, Goodman CM … +1 more , Baxby K
J R Coll Surg Edinb · 2002 Feb · PMID 11874263
OBJECTIVE: To audit the findings of a standard investigation protocol for haematuria with emphasis on the diagnosis of urological malignancy. METHODS: Data were prospectively collected on haematuria referrals to one cent...
OBJECTIVE: To audit the findings of a standard investigation protocol for haematuria with emphasis on the diagnosis of urological malignancy. METHODS: Data were prospectively collected on haematuria referrals to one centre over a 5 year period. The standard protocol of investigation included flexible cystoscopy, urine cytology and culture, upper tract imaging, consisting of a renal tract ultrasound scan and a radiograph of kidney-ureter-bladder (KUB), proceeding to an intravenous urogram (IVU) in selected patients. RESULTS: 1046 patients were examined; 63% (n = 657) had microscopic haematuria and 37% (n = 389) had frank haematuria. No malignancy was found in patients with microscopic haematuria below 50 years of age. The findings of malignancy were not associated with either the sex or duration of symptoms in either groups. No association between the presence of symptoms and the finding of malignancy was observed in the microscopic haematuria group. Twenty five percent of patients presenting with frank haematuria had malignancy compared with 3.7% of patients with microscopic haematuria (p < 0.0001). The type of haematuria (frank or microscopic) was not predictive of grade or stage of malignancy. Of patients under 70 years with frank haematuria, males were more likely than females to have malignancy. This higher risk was not observed in older patients. Urine cytology had a poor predictive value for detection of malignancy with a sensitivity of only 25%. CONCLUSION: Full investigation of all patients with frank haematuria and those with microscopic haematuria above 50 years of age, is well justified. Patients under 50 years with microscopic haematuria should have a lower priority for investigation.
Ligation of the splenic artery in operations of the spleen in children.
Roussis XS, Liasidou EK, Petropoulos AS
J R Coll Surg Edinb · 2002 Feb · PMID 11874262
BACKGROUND: Every effort is made during surgery of the spleen to preserve splenic function. This serves the purpose of maintaining the integrity of the defence mechanisms of the patient against infection in the short - a...
BACKGROUND: Every effort is made during surgery of the spleen to preserve splenic function. This serves the purpose of maintaining the integrity of the defence mechanisms of the patient against infection in the short - and long-term. With ligation of the splenic artery prior to excision of splenic lesions and splenic repair we aimed to secure control of peri- operative bleeding, thus, making feasible the preservation of the spleen. METHODS: Six patients with splenic pathology aged 5-14 years old (four boys and two girls) were operated on for splenic pathology between 1994-1999. Three had splenic cysts (dermoid), one had a hamartoma and 2 had hydatid cysts. Investigations included radiography, ultrasound scan, computerised tomography and scintigraphy. All patients were administered antibiotics and pneumovax pre-operatively. Ligation of the splenic artery was carried out with ligaclips. Congenital anomalies or hydatid cysts were excised and repair of the spleen with splenorrhaphy was performed. Peri-operative blood loss was minimal and this aided greatly in performing the excision of the splenic lesions and the repair of the spleen. RESULTS: All patients had an uncomplicated post-operative course. Scintigraphy in the follow-up from 6 months after the operation showed good splenic function. Laboratory investigations did not show decreased levels of immunological factors in the early or later post- operative period. CONCLUSION: Splenic artery ligation reduced the amount of bleeding and allowed for the preservation of the spleen in all patients in this study.
Restorative proctocolectomy: one surgeon's experience of a now routine procedure in a district general hospital.
Mukhtar H, Zak A, Berry AR
J R Coll Surg Edinb · 2002 Feb · PMID 11874261
Restorative proctocolectomy is now the operation of choice for the definitive management of ulcerative colitis and familial adenomatous polyposis coli. The aim of this review is to evaluate clinical and functional result...
Restorative proctocolectomy is now the operation of choice for the definitive management of ulcerative colitis and familial adenomatous polyposis coli. The aim of this review is to evaluate clinical and functional results of the first fifty patients treated with restorative proctocolectomy over a period of seven years. A total of 50 patients (28 males, 22 females) underwent restorative proctocolectomy over a period of seven years in our district general hospital. A retrospective analysis of hospital notes was undertaken and supplemented with a patient questionnaire. Forty-three patients had ulcerative colitis and seven had familial adenomatous polyposis coli. Two pouch designs were used, a four limbed "pear pouch" (94%) and a two limb "J" pouch (6%). The majority (98%) of patients had a stapled ileal pouch-anal anastomosis and a similar number had a defunctioning ileostomy. There was no mortality. Early complications (within 30 days of operation) occurred in 18(36%) patients. Late complications were seen in 22 (44%) patients. The median number of daily bowel movements was four (range 1-10). Pouchitis was seen in ten patients (20%). Restorative proctocolectomy is a safe procedure for patients with ulcerative colitis and familial adenomatous polyposis coli. Although total morbidity is appreciable, functional results are generally good and patient satisfaction is high.
Management of hepatocellular carcinoma.
Lau WY
J R Coll Surg Edinb · 2002 Feb · PMID 11874260
This article reviews the recent advances in the management of hepatocellular carcinoma (HCC). Partial hepatectomy still remains the mainstay of therapy for early HCC. The limits of liver resection have been extended with...
This article reviews the recent advances in the management of hepatocellular carcinoma (HCC). Partial hepatectomy still remains the mainstay of therapy for early HCC. The limits of liver resection have been extended with the use of a multi-modality approach, and neoadjuvant/adjuvant treatment has improved the results of liver resection. Orthotopic liver transplantation works better than partial hepatectomy in a subgroup of patients with poor liver function and with early HCC. For locally advanced HCC, which is still confined to the liver, debulking surgery gives excellent palliation and prolongs patient survival. Non-operative local ablative therapy shows encouraging results. Hepatic artery chemoembolisation has been shown, by systemic review or meta-analysis, to have no significant impact on patient survival. Initial results with transarterial radioembolisation are promising. For patients with advanced HCC, systemic chemotherapy has little clinical benefit. The results of systemic immunotherapy or systemic tamoxifen on HCC are controversial and need further evaluation. Early results of chemoimmunotherapy are encouraging.
Preventing fogging of spectacles whilst wearing a protective face-mask.
Reed MJ
J R Coll Surg Edinb · 2001 Dec · PMID 11768580
Abstract loading — click title to view on PubMed.
Diabetic amyotrophy masquerading as quadriceps tendon rupture: a word of caution.
Bhandankar R, Sudheer K, Rogers A
J R Coll Surg Edinb · 2001 Dec · PMID 11768579
Diabetic amyotrophy is predominantly a motor condition that involves various elements of the lumbosacral plexus but particularly that related to the femoral nerve. (1,3) It can present acutely as unilateral thigh pain fo...
Diabetic amyotrophy is predominantly a motor condition that involves various elements of the lumbosacral plexus but particularly that related to the femoral nerve. (1,3) It can present acutely as unilateral thigh pain followed by the development of weakness and later wasting in the femoral muscles, usually first seen in the quadriceps. We report on two cases of diabetic amyotrophy from different hospitals that presented with clinical signs and symptoms of quadriceps rupture. These patients underwent surgical exploration but in both the quadriceps tendons were found to be intact. Post-operative neurological consultations established the diagnosis as diabetic amyotrophy, which was confirmed with electrodiagnostic studies. We conclude that any quadriceps rupture in diabetics should be viewed with caution. Electrodiagnostic studies and imaging with ultrasound and magnetic resonance imaging should be carried out before exploratory surgery.
Extraskeletal Ewings sarcoma of the small bowel: case report and literature review.
Adair A, Harris SA, Coppen MJ … +1 more , Hurley PR
J R Coll Surg Edinb · 2001 Dec · PMID 11768578
Extraskeletal Ewings sarcoma is a tumour of neuroectodermal origin sharing close similarities with Ewings sarcoma of bone. We report the case of a 21 year old 16 week pregnant woman presenting with vomiting and weight lo...
Extraskeletal Ewings sarcoma is a tumour of neuroectodermal origin sharing close similarities with Ewings sarcoma of bone. We report the case of a 21 year old 16 week pregnant woman presenting with vomiting and weight loss and found to have an extraskeletal Ewings sarcoma of the small bowel. In a review of the literature there are no previous reports of extraskeletal Ewings sarcoma occurring in the small bowel. The diagnosis of extraskeletal Ewings sarcoma and the complicated management of a young pregnant woman with a malignant tumour are described.
A comparison between different formats of educational feedback to junior doctors: a prospective pilot intervention study.
Hadjianastassiou VG, Karadaglis D, Gavalas M
J R Coll Surg Edinb · 2001 Dec · PMID 11768577
OBJECTIVES: Audit feedback is conventionally given in the format of an average performance of the department relative to established guidelines. The impersonality of this feedback format may compromise audit outcome. The...
OBJECTIVES: Audit feedback is conventionally given in the format of an average performance of the department relative to established guidelines. The impersonality of this feedback format may compromise audit outcome. The aim of the study was to compare personal, peer-comparison feedback, an effective method of changing physician practice, to the 'conventional' departmental one. METHODS: Eleven SHOs working at a central London A&E department were audited in terms of the adequacy of their documentation process. The study comprised patients presenting with closed head injury, acute asthma and chest pain of possible cardiac origin. Personal peer-comparison feedback and average departmental feedback was given for the first two groups, respectively. No feedback was given for the chest pain group, acting as a temporal control. The outcome measure was documentation of the minimum variables, as specified by departmental guidelines. RESULTS: The peer-comparison feedback group showed a significant improvement (p-value<0.0001) in two out of three target variables audited, in contrast to the departmental feedback group and the control group which did not show a significant improvement in any of the variables. CONCLUSIONS: Personal, confidential peer-comparison feedback was more effective than departmental feedback, in an audit of process of junior doctors. This pilot study should form the basis of a larger study (more SHOs, wider range of conditions) to establish unequivocally the best format for educational feedback.
Inguinal hernia repair.
Macintyre IMC
J R Coll Surg Edinb · 2001 Dec · PMID 11768576
Inguinal hernia repair has been evolving for the past 130 years and the pace of evolution accelerated in the last decade with the introduction of the tension-free repair, the laparoscopic repair and the growth of the spe...
Inguinal hernia repair has been evolving for the past 130 years and the pace of evolution accelerated in the last decade with the introduction of the tension-free repair, the laparoscopic repair and the growth of the specialist hernia clinic. The evolution continues and this article sets out to describe the author's approach at the time of writing.
The management of brain tumours.
Macarthur DC, Buxton N
J R Coll Surg Edinb · 2001 Dec · PMID 11768575
Current knowledge on the biology and clinical features of brain tumours is reviewed with particular reference to the most commonly occurring tumours - gliomas, meningiomas and metastases. Unfortunately, the enormous incr...
Current knowledge on the biology and clinical features of brain tumours is reviewed with particular reference to the most commonly occurring tumours - gliomas, meningiomas and metastases. Unfortunately, the enormous increase in understanding of the biology of these tumours over recent years has not, as yet, been paralleled by advances in treatment or improvements in clinical outcome. Developing adjuvant therapies, ranging from novel means of delivery of radiotherapy and new chemotherapy agents to gene therapy and anti-angiogenic agents, are currently being explored and offer some hope for improvement in our ability to treat these tumours over the next few decades.
The other option in research.
Vohra HA
J R Coll Surg Edinb · 2001 Dec · PMID 11768574
As surgery advances rapidly, so the need for a more critical evaluation of new developments becomes more urgent. This is most likely to be developed in the research environment. However, a well conducted and published MS...
As surgery advances rapidly, so the need for a more critical evaluation of new developments becomes more urgent. This is most likely to be developed in the research environment. However, a well conducted and published MSc research project will earn more points in the SpR short-listing process than a poorly conducted and unpublishable two year research study that is unable to generate a thesis leading to a higher degree.
A simple method of mesorectal transection for carcinoma of upper third of rectum.
Srinivas Y, Renwick A, McArdle P … +1 more , MacDonald A
J R Coll Surg Edinb · 2001 Dec · PMID 11768573
Abstract loading — click title to view on PubMed.
Pouchitis following restorative proctocolectomy for ulcerative colitis: incidence and therapeutic outcome.
Madiba TE, Bartolo DC
J R Coll Surg Edinb · 2001 Dec · PMID 11768572
BACKGROUND: Pouchitis is a significant sequel of restorative proctocolectomy. This study was undertaken to document the incidence of pouchitis at the Edinburgh Royal Infirmary and to assess outcome of treatment with metr...
BACKGROUND: Pouchitis is a significant sequel of restorative proctocolectomy. This study was undertaken to document the incidence of pouchitis at the Edinburgh Royal Infirmary and to assess outcome of treatment with metronidazole. METHODS: Patients who developed pouchitis following restorative proctocolectomy for ulcerative colitis form the basis of this study. Pouchitis was suspected if patients developed diarrhoea with or without blood, mucus or pus. Diagnosis was confirmed with pouch endoscopy and biopsy. RESULTS: From 1990 to 1999 (10 years) 139 patients underwent restorative proctocolectomy and ileo-anal pouch anastomosis (135 J pouches and 4 W pouches). Their median age was 35 years (range 13-74). There were 68 females and 71 males. The indication for operation was failed medical treatment in 104 patients and toxic megacolon in 35. Forty-seven patients (34%) developed pouchitis (21 females and 26 males). Symptoms were diarrhoea (35), diarrhoea, mucus and pus (5) and diarrhoea and blood (7). Symptoms of pouchitis started at an average of 33.51 + 29.2 months (range 2-102, median 18). All patients were treated with metronidazole for a minimum of one month. Thirty-six patients (77%) resolved on metronidazole alone. Nine patients (19%) went on to develop chronicity and were managed by long-term metronidazole (and/or ciprofloxacin). A further 2 patients (4%) had treatment resistant pouchitis and required pouch excision. CONCLUSION: Pouchitis is common following restorative proctocolectomy for ulcerative colitis. Treatment with metronidazole is associated with improvement in the majority of cases. In patients with chronic pouchitis maintenance of remission is possible with antibiotics. A high index of suspicion is advocated in patients who develop severe diarrhoea following this procedure.
Venous thromboembolism prophylaxis used by consultant general surgeons in Scotland.
Burns PJ, Wilsom RG, Cunningham C
J R Coll Surg Edinb · 2001 Dec · PMID 11768571
BACKGROUND: Venous thromboembolism (VTE) is a common source of morbidity and mortality in general surgical patients. Guidelines have been produced to help guide doctors through the complex issue of VTE prophylaxis. This...
BACKGROUND: Venous thromboembolism (VTE) is a common source of morbidity and mortality in general surgical patients. Guidelines have been produced to help guide doctors through the complex issue of VTE prophylaxis. This study intended to examine the use of VTE prophylaxis amongst general surgeons in Scotland, with reference to nationally produced guidelines. METHOD: A postal questionnaire was sent to all consultant general surgeons in Scotland. They were asked to give their opinion on the best means of VTE prophylaxis in six different clinical scenarios. The responses were evaluated with reference to the guidelines from the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: A 69% response rate was achieved. There was a wide variance in the suggested prophylaxis in each of the scenarios. With reference to SIGN guidelines, 35% of responses represented undertreatment, 16% overtreatment and 49% appropriate treatment. CONCLUSION: Despite the publication of VTE guidelines, there is still a wide variety of opinions amongst consultant general surgeons with regards to VTE prophylaxis. Many of the responses were not consistent with such guidelines and represent suboptimal prophylaxis for patients.
Nutrition, diet and oral health.
Rugg-Gunn AJ
J R Coll Surg Edinb · 2001 Dec · PMID 11768570
Teeth are valued, not least for their contribution to appearance and social acceptability. The cost of treating oral disease, though, is high--about 2.2 billion pounds in the UK in 1999-2000. Nutrition and diet are major...
Teeth are valued, not least for their contribution to appearance and social acceptability. The cost of treating oral disease, though, is high--about 2.2 billion pounds in the UK in 1999-2000. Nutrition and diet are major determinants of oral health or disease and the purpose of this lecture was to review their impact on the more important oral diseases: defects in the structure and appearance of teeth, dental caries, dental erosion, periodontal disease, noma, and oral cancer. There is growing realisation of the detrimental impact of dental impairment on food choice, nutrient intake and nutritional status. A common feature of many of these diseases is that the causes are well known. However, they are not yet preventable because their aetiology (and prevention) is intimately involved with lifestyle. Nevertheless, there are some hopeful signs of progress being made in several areas.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe