Journal Of The Royal College Of Surgeons Of Edinburgh[JOURNAL]
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200 papers
Acute abdomen--remember spontaneous perforation of the urinary bladder.
Basavaraj DR, Zachariah KK, Feggetter JG
J R Coll Surg Edinb · 2001 Oct · PMID 11697704
Spontaneous perforation of the urinary bladder is a rare clinical condition presenting as an acute abdomen. It should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and thos...
Spontaneous perforation of the urinary bladder is a rare clinical condition presenting as an acute abdomen. It should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumour in the bladder. Disproportionately elevated serum urea and creatinine should raise the index of suspicion. A case of spontaneous perforation of the bladder, five years following successful treatment of a bladder tumour by radiotherapy, is reported.
Unusual sites (thorax and umbilical hernial sac) of endometriosis.
Yuen JS, Chow PK, Koong HN … +2 more , Ho JM, Girija R
J R Coll Surg Edinb · 2001 Oct · PMID 11697703
Extra-pelvic endometriosis in the thorax or umbilical hernia is rare. We report a case of thoracic endometriosis presenting with isolated chest pain and a case of endometriosis in an umbilical hernial sac mimicking incar...
Extra-pelvic endometriosis in the thorax or umbilical hernia is rare. We report a case of thoracic endometriosis presenting with isolated chest pain and a case of endometriosis in an umbilical hernial sac mimicking incarceration. The clinical course and management of the patients and a literature review of these two unusual sites of endometriosis are discussed.
Synchronous perforation of a Meckel's diverticulum and a duodenal ulcer.
Saunders JR, Griffiths MP, Kadirkamanathan SS
J R Coll Surg Edinb · 2001 Oct · PMID 11697702
Dual perforation of the gastrointestinal tract is rare. We present a case of a patient who presented with a simultaneous perforation of a Meckel's diverticulum and a duodenal ulcer.
Dual perforation of the gastrointestinal tract is rare. We present a case of a patient who presented with a simultaneous perforation of a Meckel's diverticulum and a duodenal ulcer.
Chronic contained leak of abdominal aortic aneurysm presenting as lumbar neuropathy.
Ramasamy PR, Fox D, Narendra G … +2 more , Carnie L, Watura R
J R Coll Surg Edinb · 2001 Oct · PMID 11697701
Chronic contained rupture of aortic aneurysm is a rare event which can cause diagnostic difficulties. It can present as high lumbar neuropathy, hence, chronic contained rupture should be borne in mind while examining pat...
Chronic contained rupture of aortic aneurysm is a rare event which can cause diagnostic difficulties. It can present as high lumbar neuropathy, hence, chronic contained rupture should be borne in mind while examining patients with back pain. Delayed diagnosis and delayed surgical repair of the ruptured aneurysm can compromise the final results. The outcome of urgent repair of a chronic contained leak is equivalent to that of elective aneurysm repairs.
Malignant transformation in congenital sebaceous naevi in childhood.
Dunkin CS, Abouzeid M, Sarangapani K
J R Coll Surg Edinb · 2001 Oct · PMID 11697700
Sebaceous naevi are uncommon congenital skin lesions with a well-recognised potential for neoplastic change. They should be considered premalignant lesions as malignant degeneration, most commonly basal cell carcinoma an...
Sebaceous naevi are uncommon congenital skin lesions with a well-recognised potential for neoplastic change. They should be considered premalignant lesions as malignant degeneration, most commonly basal cell carcinoma and squamous cell carcinoma, occurs with a lifetime risk of between 5% and 22%. This incidence is equal to that of actinic keratosis and exceeds that of oral leukoplakia. Such change, however, is rare before puberty. Basal cell carcinoma may develop in children with naevoid basal cell carcinoma syndrome, xeroderma pigmentosum and rarely de novo but sebaceous naevus is the only solitary lesion in childhood associated with the development of basal cell carcinoma. We present two cases of malignant transformation in a congenital sebaceous naevus occurring in childhood and review the literature and discuss the evidence upon which to base management guidelines.
Hypoxia and surgical patients--prevention and treatment of an unnecessary cause of morbidity and mortality.
Strachan L, Noble DW
J R Coll Surg Edinb · 2001 Oct · PMID 11697699
Hypoxia is a common phenomenon peri-operatively. Although mild hypoxaemia of short duration is likely to have little effect more severe and prolonged hypoxaemia can seriously affect surgical outcome. Rational use of oxyg...
Hypoxia is a common phenomenon peri-operatively. Although mild hypoxaemia of short duration is likely to have little effect more severe and prolonged hypoxaemia can seriously affect surgical outcome. Rational use of oxygen therapy may limit these adverse effects.
Audit of acute pancreatitis management: a tale of two hospitals.
Dube MG, Lobo DN, Rowlands BJ … +1 more , Beckingham IJ
J R Coll Surg Edinb · 2001 Oct · PMID 11697698
BACKGROUND: A case note audit of existing practices in the management of acute pancreatitis (AP) at a district general hospital (DGH) and a teaching hospital was undertaken to determine if practices were in accordance wi...
BACKGROUND: A case note audit of existing practices in the management of acute pancreatitis (AP) at a district general hospital (DGH) and a teaching hospital was undertaken to determine if practices were in accordance with published UK guidelines. METHODS: Casenotes of all adults admitted with AP over a period of one year at the two hospitals were reviewed. RESULTS: Ninety-five patients were treated for AP at the teaching hospital and 52 at the DGH. The age, sex and aetiological distributions at the two hospitals were similar. Fifteen (15.8%) patients at the teaching hospital and eight (15.3%) at the DGH had severe AP. Four patients died at each hospital. Prognostic Glasgow criteria tests (excluding LDH) were completed within 48 hours in 43% patients at the teaching hospital and 48% at the DGH. Five of the twenty-five cholecystectomies at the teaching hospital and 4/18 at the DGH were performed within four weeks after admission with AP. CONCLUSION: Audit of current practice has highlighted deficiencies at many levels compared with current evidence-based guidelines, although this has not resulted in unexpected mortality. It remains to be seen whether new measures to aid compliance with guidelines will result in improvement in morbidity and mortality.
Per anal excision of large rectal adenomas using an endoscopic stapler.
Allison SI, Adedeji A, Varma JS
J R Coll Surg Edinb · 2001 Oct · PMID 11697697
Large rectal adenomas can be approached per-anally by open excision or by transanal endoscopic microsurgery (TEMS). We describe the adaptation of an endoscopic linear stapler-cutter for per anal excision of rectal polyps...
Large rectal adenomas can be approached per-anally by open excision or by transanal endoscopic microsurgery (TEMS). We describe the adaptation of an endoscopic linear stapler-cutter for per anal excision of rectal polyps. It can be used for difficult polyps with minimal risk of complications and is easier and more accessible than TEMS.
Clinical case histories and sketches of gun-shot injuries from the Carlist War.
Kaufman MH
J R Coll Surg Edinb · 2001 Oct · PMID 11697696
The Anatomical Museum of the University of Edinburgh contains a substantial collection of human osteological preparations that display the effects of musket-ball and sabre injuries. Most of these formerly belonged to the...
The Anatomical Museum of the University of Edinburgh contains a substantial collection of human osteological preparations that display the effects of musket-ball and sabre injuries. Most of these formerly belonged to the Museum Collection associated with the class of Military Surgery. This collection had principally been amassed by Sir George Ballingall to illustrate his lectures when he was Regius Professor of Military Surgery in the University of Edinburgh from 1822-55. About half of the osteological preparations in his collection had been purchased from Dr Rutherford Alcock in 1843. Alcock had collected them when he was Deputy Inspector General of Hospitals to the British Auxiliary Legion in Spain during the Carlist War of 1835-37. Just under 60% of the osteological preparations purchased from Alcock still remain on display in the Anatomy Museum of the University of Edinburgh. Previously, the only information on these items was that published in Ballingall's Catalogue of the Museum attached to the Class of Military Surgery, published in 1855. Very recently, twelve volumes of manuscript material, consisting principally of clinical case records prepared by Alcock and his medical officers have been located in the Special Collections Section of Edinburgh University Library. This has now enabled the full clinical case records of the majority of the individuals whose osteological preparations are still available in the collection to be studied. This manuscript material provides a unique record of the treatment of the sick and wounded men in this campaign. It also allows the clinical records of men wounded by musket-ball to be studied with their associated bony lesions.
McDowell's saucer.
Gardner DL
J R Coll Surg Edinb · 2001 Oct · PMID 11697695
The pioneer American ovariotomist McDowell studied anatomy in Edinburgh under John Bell. McDowell returned to Kentucky in 1793 with a set of porcelain. One saucer from his set was donated to the College in 1994.
The pioneer American ovariotomist McDowell studied anatomy in Edinburgh under John Bell. McDowell returned to Kentucky in 1793 with a set of porcelain. One saucer from his set was donated to the College in 1994.
Incidence of loose bodies in an osteoarthritic hip.
Rai NN, Siney PD, Fleming PA … +1 more , Wroblewski BM
J R Coll Surg Edinb · 2001 Oct · PMID 11697694
In a prospective study of 75 consecutive primary Charnley low friction arthroplasties carried out for osteoarthritis, loose bodies were found in nine hip joints; an incidence of 12%. Whether their presence is the cause o...
In a prospective study of 75 consecutive primary Charnley low friction arthroplasties carried out for osteoarthritis, loose bodies were found in nine hip joints; an incidence of 12%. Whether their presence is the cause or the effect of the condition remains unclear. Their discoid or spherical shape suggests that they were free and had been subjected to sliding or rolling motion. Those of irregular shape may have remained partly attached within the capsule, or become confined to a space.
Amputations: no longer the end of the road.
Turney BW, Kent SJ, Walker RT … +1 more , Loftus IM
J R Coll Surg Edinb · 2001 Oct · PMID 11697693
BACKGROUND: The aim of this prospective study was to assess the effect of an intensive in-patient rehabilitation programme upon the mobility of amputees. METHODS: All major lower limb amputations between 1997 and 1999 re...
BACKGROUND: The aim of this prospective study was to assess the effect of an intensive in-patient rehabilitation programme upon the mobility of amputees. METHODS: All major lower limb amputations between 1997 and 1999 received a pre-operative mobility assessment and, where appropriate, were referred for a vigorous rehabilitation programme. RESULTS: 92 lower limb amputations were performed in 87 patients (57 below knee, 33 above knee, two hip disarticulations). Overall, 63% of patients were able to ambulate independently following rehabilitation. Univariate analysis revealed that the only predictor of mobility was the level of amputation, below knee gaining better mobility than above knee (p=0.002). CONCLUSION: Lower limb amputees should participate in an aggressive in-patient physiotherapy regimen since reasonable mobility can be achieved in the majority of patients.
Focused rigidity casting: a prospective randomised study.
Cohen AP, Shaw DL
J R Coll Surg Edinb · 2001 Oct · PMID 11697692
Focused rigidity casting was compared with standard casting in a randomised prospective study. Two hundred consecutive patients attending a fracture clinic were assigned to have either a standard cast consisting of synth...
Focused rigidity casting was compared with standard casting in a randomised prospective study. Two hundred consecutive patients attending a fracture clinic were assigned to have either a standard cast consisting of synthetic or plaster of paris, or a focused rigidity cast of synthetic material. Patients were assessed using a specially developed scoring system termed the Bradford Plaster Index. In patients with fractures of the base of fifth metatarsal, focused rigidity casting proved superior to traditional techniques for ability score (p=0.0001), satisfaction score (p=0.0023), overall impairment of function (p=0.019), limitation of movement following cast removal (p=0.024) and in limitation of muscle strength following cast removal (p=0.001). In fractures of the distal radius, focused rigidity casting was superior for ability score (p=0.0002) and satisfaction score (p=0.00009). Patients with scaphoid fractures were better for satisfaction score (p=0.0483). Compared with the standard technique, focused rigidity casting has been shown to be superior to traditional methods with regard to satisfaction and functional scores without any detriment to clinical results.
Tooth extraction, bleeding and pain control.
Al-Bahlani S, Sherriff A, Crawford PJ
J R Coll Surg Edinb · 2001 Oct · PMID 11697691
Local anaesthesia is used routinely in dental surgery; it is effective in both pain control and--through the vasoconstrictors often contained within it--the reduction of bleeding. The extraction of deciduous teeth under...
Local anaesthesia is used routinely in dental surgery; it is effective in both pain control and--through the vasoconstrictors often contained within it--the reduction of bleeding. The extraction of deciduous teeth under general anaesthesia is often carried out without these local effects. There are no previous studies to investigate the combined effect of local anaesthesia with general anaesthesia on blood loss and pain control. A randomised, controlled clinical trial was carried out with one hundred children aged 3-5 years. Ethical approval and informed consent were obtained. Surface anaesthetic cream (EMLA) was placed on the hand into which the intravenous access was to be placed. One to two ml of blood was taken at the time of induction as a baseline of the patient's level of haematin pigment. Children in the experimental group were given one quarter of a cartridge (0.5 ml) of local anaesthetic containing epinephrine (1:80,000) in each quadrant before tooth extraction; all blood in swabs, suction equipment and disposables was collected and digested with NaOH. The children were observed for 11 minutes post-operatively for any signs of distress. Total blood loss was calculated by comparison of the baseline sample and the shed blood digests. This study showed that using local anaesthesia for dental extractions under general anaesthesia was associated with decreased blood loss (p = 0.001). The second finding--which has not been reported before--was that this use of local anaesthesia was shown to cause distress to this age group of children upon recovery from the general anaesthetic (p <0.0001). The use of local anaesthetic in this situation provided a useful reduction in post-operative bleeding. However, its use was associated with greater post-operative distress.
Role of thoracic surgery in patients suffering from Acquired Immune Deficiency Syndrome.
Ahmed SH
J R Coll Surg Edinb · 2001 Oct · PMID 11697690
BACKGROUND AND PURPOSE: To study the role of thoracic surgery in patients suffering from Acquired Immune Deficiency Syndrome (AIDS) in a South Bronx community with a high incidence of the disease. METHODS: A retrospectiv...
BACKGROUND AND PURPOSE: To study the role of thoracic surgery in patients suffering from Acquired Immune Deficiency Syndrome (AIDS) in a South Bronx community with a high incidence of the disease. METHODS: A retrospective analysis of medical records of patients who underwent thoracic surgery at Bronx-Lebanon hospital, New York, over a three year period between 1996-1998. RESULTS: The thoracic surgeons at Bronx-Lebanon Hospital in New York operated upon a total of 210 patients. Of these, 39 were operated upon for AIDS-related illnesses, comprising 17% of the operative workload. The indications of surgery in these patients were variable, ranging from infections to tumours. Fifteen patients were operated on for pericardial effusion. Ten were operated on for empyema, which had failed to resolve with thoracostomy alone and necessitated decortication. Tumours also formed a significant portion of the surgical workload. Three patients had Kaposi's sarcoma of the lung and three had a primary lymphoma in the lung. The mortality rate was high (46%). CONCLUSION: The data suggest that surgical intervention in AIDS-related chest diseases is unable to alter the course of the disease. Earlier detection and intervention of these complications may improve outcome in some patients.
Fireworks injury: temporal bone penetration and a wooden intra-cranial foreign body.
Al Mulla A, Purva M, Behbehani A
J R Coll Surg Edinb · 2001 Aug · PMID 11523722
We describe a case of a teenager sitting in a car, who was struck by a fireworks missile. The unusual presentation of a large wooden foreign body penetrating through the temporal bone and lodging in the brain is detailed...
We describe a case of a teenager sitting in a car, who was struck by a fireworks missile. The unusual presentation of a large wooden foreign body penetrating through the temporal bone and lodging in the brain is detailed. The management is discussed.
Post-partum ovarian vein thrombosis.
Warde L, McDermott EW, Hill AD … +2 more , Gibney RG, Murphy JJ
J R Coll Surg Edinb · 2001 Aug · PMID 11523721
Post-partum ovarian vein thrombosis (POVT) is uncommon, but the true incidence is not known. Ninety per cent of cases present as right iliac fossa pain within 10 days of delivery. Anti-coagulation and intravenous antibio...
Post-partum ovarian vein thrombosis (POVT) is uncommon, but the true incidence is not known. Ninety per cent of cases present as right iliac fossa pain within 10 days of delivery. Anti-coagulation and intravenous antibiotics are the mainstay of treatment. We report three cases that were referred to our unit. These cases illustrate the difficulty in the clinical diagnosis of POVT and highlight the importance of its inclusion in the differential diagnoses of an acute abdomen in post-partum patients. POVT can be accurately diagnosed by appropriate noninvasive investigations and a laparotomy avoided.
Talc serodesis--report of four cases.
Holthouse DJ, Chleboun JO
J R Coll Surg Edinb · 2001 Aug · PMID 11523720
Talc is a known stimulator of fibrosis in biological systems. We present four cases in which instillation of talc in to serous cavities have produced obliteration of these cavities. No side-effects were noted.
Talc is a known stimulator of fibrosis in biological systems. We present four cases in which instillation of talc in to serous cavities have produced obliteration of these cavities. No side-effects were noted.
Near total transection of the trachea following percutaneous dilatational tracheostomy.
Kedjanyi WK, Gupta D
J R Coll Surg Edinb · 2001 Aug · PMID 11523719
The bedside procedure of percutaneous dilatational tracheostomy (PDT) in the intensive care unit continues to gain popularity. Percutaneous dilatational tracheostomy is recommended as simple, safe and cost-effective. The...
The bedside procedure of percutaneous dilatational tracheostomy (PDT) in the intensive care unit continues to gain popularity. Percutaneous dilatational tracheostomy is recommended as simple, safe and cost-effective. The procedure can be associated with serious life-threatening complications. We report a case of near total transection of the trachea following PDT.
Surgical treatment of a tomaculous neuropathy.
Taggart TF, Allen TR
J R Coll Surg Edinb · 2001 Aug · PMID 11523718
Compressive neuropathy of the ulnar nerve at the elbow is the second most common nerve entrapment in the upper limb. Eight possible anatomical points of constriction have been identified. The most common constriction bei...
Compressive neuropathy of the ulnar nerve at the elbow is the second most common nerve entrapment in the upper limb. Eight possible anatomical points of constriction have been identified. The most common constriction being the intermuscular septum proximally or between the two heads of the flexor carpi ulnaris in the cubital canal distally. Surgical release is successful in 80-90% of cases. Certain rare genetic conditions can predispose susceptible peripheral nerves to similar compressive neuropathies but there is no literature on surgical treatment of such patients. We present a case of hereditary neuropathy with liability to pressure palsy (HNPP) often known as 'tomaculous' neuropathy, in a patient with ulnar nerve symptoms who underwent a surgical release.
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