Nephrogenic diabetes insipidus (NDI) presents an uncommon but formidable clinical challenge in the surgical patient. Two recent cases of NDI with differing aetiology are presented. These cases and a review of the literat...Nephrogenic diabetes insipidus (NDI) presents an uncommon but formidable clinical challenge in the surgical patient. Two recent cases of NDI with differing aetiology are presented. These cases and a review of the literature illustrate well the diagnosis, fluid and electrolyte imbalances seen and the strategy of treatment required in the post-operative setting. The central role of the recently discovered aquaporin channels in this condition is briefly outlined. Nephrogenic diabetes insipidus has a diverse aetiology and many of the hazards of the condition are peculiar to the surgical setting. The importance of management in a high dependency environment is highlighted.
Rapidly proliferating haemangiomas of the face may obscure vision with the development of deprivation amblyopia. Early intervention is required to prevent complications. We present a case successfully treated with a comb...Rapidly proliferating haemangiomas of the face may obscure vision with the development of deprivation amblyopia. Early intervention is required to prevent complications. We present a case successfully treated with a combination of pulsed dye laser and intralesional steroid injection. The current management of haemangiomas is reviewed.
The medical career of a Scottish doctor, James Wardrop, in the 19th century is described. An early interest in the developing science of Pathology in the Royal College of Surgeons of Edinburgh was expanded further when h...The medical career of a Scottish doctor, James Wardrop, in the 19th century is described. An early interest in the developing science of Pathology in the Royal College of Surgeons of Edinburgh was expanded further when he moved to London, due to financial needs. Despite being outside the London teaching hospital scene, he continued to publish and teach in the private schools of the time. His interest in ophthalmology led him to describe what we now know as retinoblastoma, with recommendation for treatment. He also described sympathetic ophthalmitis and performed paracentesis in acute angle-closure glaucoma. He became surgeon to the Prince of Wales, later King George IV, but his criticism of other medical men at court led to his exclusion from the King at the scene of his death. He owned a notable collection of pictures and presented two of them to the National Gallery of Scotland on its foundation in 1850. In recent years, his work has been recognised by leading ophthalmologists, particularly in the USA. The Library of the Royal College of Surgeons of Edinburgh contains several of his works, and his portrait hangs in the College.
A number of controversies exist in the treatment of differentiated thyroid carcinoma with respect to the extent of surgery, use of radioactive iodine and post-operative thyroxine suppression. Recent recognition of progno...A number of controversies exist in the treatment of differentiated thyroid carcinoma with respect to the extent of surgery, use of radioactive iodine and post-operative thyroxine suppression. Recent recognition of prognostic factors has helped to assign patients, based on their risk profile, as being at high risk of developing recurrence. This has facilitated the development of a selective approach to therapy, thus, avoiding unnecessary treatment and reducing morbidity without compromising treatment outcome. This review attempts to evaluate the current concepts of management of differentiated thyroid carcinoma in the light of these new developments.
The purpose of this article is to discuss the benefits of and to illustrate a framework for appraisal. The place of career advice in this process is mentioned, as is a brief discussion on assessment. From the point of vi...The purpose of this article is to discuss the benefits of and to illustrate a framework for appraisal. The place of career advice in this process is mentioned, as is a brief discussion on assessment. From the point of view of the individual doctor, information to help him/her choose an appropriate career path should be readily available. It is more likely that a doctor will perform well throughout their career if in a career or occupation that suits them.
The Nottingham Prognostic Index (NPI) is a prognostic variable suitable for the stratification of breast cancer patients for adjuvant systemic treatment. The impact of sentinel node biopsy (SNB) and of the assessment of...The Nottingham Prognostic Index (NPI) is a prognostic variable suitable for the stratification of breast cancer patients for adjuvant systemic treatment. The impact of sentinel node biopsy (SNB) and of the assessment of nodal involvement was evaluated in 136 successful SNB procedures completed by axillary dissection (AD). The three strategies assessed included SNB and AD in all cases, AD only in SN-positive cases, and AD only if the SN contained macrometastases. Isolated tumour cells in lymph nodes were regarded either as metastases or as negative findings. The success rate and accuracy of SNB were 90% and 96%, respectively. The NPI was influenced by variations in the surgical staging strategy and the definition of nodal involvement, in at most, five patients. Adjuvant systemic treatment, indicated on the basis of the NPI is less influenced by staging strategies and definitions of metastases than that given on the basis of nodal status alone.
Simple renal cysts are uncommon in children and their presentation and management has changed with increasing use of ultrasound scans. The aim of this study was to review our experience and highlight some peculiarities i...Simple renal cysts are uncommon in children and their presentation and management has changed with increasing use of ultrasound scans. The aim of this study was to review our experience and highlight some peculiarities in diagnosis and management of these cases. Eight cases were diagnosed and two symptomatic cases underwent aspiration under ultrasound guidance; one case recurred and required re-aspiration. Differentiation of simple renal cysts from other cystic lesions of the kidney, aspiration of symptomatic cysts and the importance of long-term follow-up are discussed.
Pharyngo-oesophageal strictures are not uncommon in corrosive injuries either alone or in association with dense strictures further down the oesophagus. Strictures at the pharyngo-oesophageal junction require preliminary...Pharyngo-oesophageal strictures are not uncommon in corrosive injuries either alone or in association with dense strictures further down the oesophagus. Strictures at the pharyngo-oesophageal junction require preliminary correction prior to oesophageal bypass since surgical bypass to the pharynx above the cricopharyngeal junction is associated with risk of aspiration. A one stage island pectoralis major myocutaneous flap has been used in four patients who had a non-dilatable dense cricopharyngeal stricture leading to a segment of near normal oesophagus followed by dense stricturing of the thoracic oesophagus. This procedure was followed by oesphagocolic bypass at a second stage from the cervical oesophagus to the stomach. The preliminary pectoralis major flap correction avoids problems such as aspiration or choking associated with pharyngo-colic anastomosis for oesophageal bypass. All four patients had uncomplicated healing. Post-operative endoscopy showed easy passage through the cricopharynx with a dilated cervical oesophagus partly lined by skin. Normal swallowing was restored by a second stage oesphago-colic bypass 6 weeks after the pectoralis major flap repair in two patients while the other two are awaiting the second stage. Island pectoralis major myocutaneous flap is simple, has a dependable vascularity and offers one stage correction for isolated cricopharyngeal corrosive stricture. It can also be used prior to oesophagocolic bypass in patients who have further strictures in the thoracic oesophagus.
Cystosarcoma phyllodes is a rare tumour of the breast whose clinical behaviour does not correlate well with histological findings. The optimal treatment of this tumour remains controversial. A retrospective study on the...Cystosarcoma phyllodes is a rare tumour of the breast whose clinical behaviour does not correlate well with histological findings. The optimal treatment of this tumour remains controversial. A retrospective study on the treatment and outcome of women diagnosed with cystosarcoma phyllodes between 1986 and 1998 in Brunei was undertaken. Twenty-seven women were diagnosed over the 13-year study period. Follow-up was complete in 26 cases. The mean age at diagnosis was 35 years. There were 19 (73%) histologically benign lesions, 3 (12%) borderline lesions and 4 (15%) malignant lesions. The mean follow-up period was 37 months. Four patients (16%) had recurrences after surgery (1 benign, 1 borderline and 2 malignant lesions). Mean time to recurrence was 9 months. Breast-conserving surgery with adequate resection margin is advocated in benign and borderline lesions. For malignant lesions, simple mastectomy without routine axillary dissection is recommended. More research is required to determine the role of adjuvant chemotherapy and radiotherapy in the management of malignant cystosarcoma phyllodes [corrected].
PURPOSE: Formation of an anastomotic aneurysm in the femoral artery is one of the major complications after femoral artery surgery. The aim of this study was to assess the method of repair of femoral anastomotic aneurysm...PURPOSE: Formation of an anastomotic aneurysm in the femoral artery is one of the major complications after femoral artery surgery. The aim of this study was to assess the method of repair of femoral anastomotic aneurysms and their outcome in a District General Hospital. METHODS: A retrospective consecutive cohort of anastomotic femoral aneurysms, operated between 1977 and 1998, were studied. RESULTS: Twelve patients with a total of 19 pseudoaneurysms were treated. Five of the aneurysms were repaired using a vein patch and two had re-suturing of the anastomosis. Twelve aneurysms were repaired with complete revision of the anastomoses using interposition grafts. There were no recurrences in the interposition graft group whilst two recurred in the seven aneurysms repaired using re-suturing/vein patch. CONCLUSION: Interposition grafting would appear to be the method of choice for repair of femoral pseudoaneurysms as the outcome was better than that with re-suturing or using a patch closure technique.