Journal Of The Royal College Of Surgeons Of Edinburgh[JOURNAL]
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200 papers
Transient hemi-diaphragmatic paralysis following neck surgery: report of a case and review of the literature.
McCaul JA, Hislop WS
J R Coll Surg Edinb · 2001 Jun · PMID 11478021
Diaphragmatic paresis following trauma to the phrenic nerves is a rare complication after neck surgery. The resulting elevation of the ipsilateral hemi-diaphragm is diagnosed on post-operative chest radiography and may b...
Diaphragmatic paresis following trauma to the phrenic nerves is a rare complication after neck surgery. The resulting elevation of the ipsilateral hemi-diaphragm is diagnosed on post-operative chest radiography and may be confirmed by ultrasound or fluoroscopy. When unilateral, this may lead to respiratory, cardiac or gastrointestinal symptoms and atelectasis and pulmonary infiltrates on radiography. If nerve damage is bilateral a period of ventilation may be required.
Laparoscopic port site recurrence in the absence of intra-abdominal disease.
Patton MS, Park KG
J R Coll Surg Edinb · 2001 Jun · PMID 11478020
A case is reported of a patient who presented with recurrent tumour at the site of a laparoscopy port where there had been no evidence of intra-abdominal tumour. Possible mechanisms of recurrence are postulated including...
A case is reported of a patient who presented with recurrent tumour at the site of a laparoscopy port where there had been no evidence of intra-abdominal tumour. Possible mechanisms of recurrence are postulated including a haematogenous spread of the primary tumour and the implantation at the port site.
Obscure gastrointestinal bleeding due to carcinoid tumours of the small bowel: problems in diagnosis and localisation.
Machado N, Grant CS
J R Coll Surg Edinb · 2001 Jun · PMID 11478019
Patients with obscure gastrointestinal bleeding are often difficult to manage and frequently undergo extensive investigations. The diagnosis is particularly difficult when the bleeding arises from small lesions in the sm...
Patients with obscure gastrointestinal bleeding are often difficult to manage and frequently undergo extensive investigations. The diagnosis is particularly difficult when the bleeding arises from small lesions in the small bowel that is not easily accessible for direct visualisation. We report two patients with obscure gastrointestinal bleeding from carcinoid tumours of the small bowel, highlighting the problems in diagnosis and localisation.
Muir-Torre syndrome.
Coldron J, Reid I
J R Coll Surg Edinb · 2001 Jun · PMID 11478018
Muir-Torre syndrome is a rare autosomal dominant condition in which multiple primary malignancies occur together with a sebaceous gland tumour. Early recognition of the syndrome in patients with sebaceous gland tumours s...
Muir-Torre syndrome is a rare autosomal dominant condition in which multiple primary malignancies occur together with a sebaceous gland tumour. Early recognition of the syndrome in patients with sebaceous gland tumours should facilitate early detection of subsequent malignancies if the patient with entered into appropriate screening programmes. A case occurring in Scotland is described and implications for management, screening for members of the family are discussed.
Bilateral gynaecomastia as the primary complaint in hyperthyroidism.
Tan YK, Birch CR, Valerio D
J R Coll Surg Edinb · 2001 Jun · PMID 11478017
Association of gynaecomastia with hyperthyroidism is uncommon but has been well documented in the past. Gynaecomastia in a patient with hyperthyroidism rarely presents as a primary complaint. When this occurs, it may pre...
Association of gynaecomastia with hyperthyroidism is uncommon but has been well documented in the past. Gynaecomastia in a patient with hyperthyroidism rarely presents as a primary complaint. When this occurs, it may present a diagnostic challenge to the clinician. We present the case of a patient who was referred initially to the breast clinic with bilateral gynaecomastia. Hyperthyroidism was subsequently confirmed and treated; gynaecomastia regressed with return to the euthyroid state.
Carotid artery aneurysm secondary to cystic medial necrosis.
Lau H, Cheng SW, Lam KY
J R Coll Surg Edinb · 2001 Jun · PMID 11478016
Carotid artery aneurysm secondary to cystic medial necrosis is a rare clinical entity. We report a 59-year-old Chinese male patient who presented with a pulsatile right neck swelling for 2 months. Partial resection of th...
Carotid artery aneurysm secondary to cystic medial necrosis is a rare clinical entity. We report a 59-year-old Chinese male patient who presented with a pulsatile right neck swelling for 2 months. Partial resection of the aneurysm with primary anastomosis of the internal carotid artery was performed. Histopathological examination of the aneurysmal wall demonstrated cystic degeneration of the media with accumulation of glycosaminoglycan material, consistent with the features of cystic medial necrosis. The pathogenesis of carotid artery aneurysm secondary to cystic medial necrosis is discussed.
Clinical audit: can we improve further?
Babu ED, Khan AZ, Khashaba A … +4 more , Kishore M, Ramachandiran S, Patil PM, Kulandaivel S
J R Coll Surg Edinb · 2001 Jun · PMID 11478015
Clinical audit is an important tool for comparing one's practice against existing standards. The authors have analysed the Junior Doctor's understanding of audit by performing a survey and questionnaire from 146 trainees...
Clinical audit is an important tool for comparing one's practice against existing standards. The authors have analysed the Junior Doctor's understanding of audit by performing a survey and questionnaire from 146 trainees, SpRs and SHOs from nine hospitals. The study showed that 107 (72.8%) performed audit and among those who performed audit, 52 (48.6%) experienced difficulty in obtaining data. This study highlights the importance of support needed to encourage the junior doctors to participate in audit programmes.
The hepatic artery: a reminder of surgical anatomy.
Jones RM, Hardy KJ
J R Coll Surg Edinb · 2001 Jun · PMID 11478014
This study was carried out to document the anatomy of the hepatic artery with the purpose of reminding surgeons of the need for this essential knowledge in order to practice safe hepatobiliary surgery. Repeated surgical...
This study was carried out to document the anatomy of the hepatic artery with the purpose of reminding surgeons of the need for this essential knowledge in order to practice safe hepatobiliary surgery. Repeated surgical mistakes on patients referred to our unit prompted the study. One hundred and eighty consecutive livers procured for transplantation was studied, and the anatomy drawn immediately after dissection. The left hepatic artery arose from the left gastric artery in 15%, and either the splenic, gastroduodenal artery or the aorta in 4% of cases. The right hepatic artery arose from the superior mesenteric artery in 15%, the gastroduodenal, right gastric artery or aorta in 10% of cases. There was a major variation of the coeliac axis in 9% of cases studied. Overall, there was an abnormality in 43% of dissections: 48% were multiple and 27% had more than two vascular variations. A constant pattern of abnormalities occurred in the anatomy of the hepatic artery. Realisation of this vascular pattern should make identification of the anatomy easier. When there is one vascular variation, there is a high chance of there being multiple variations.
Dendritic cells (II): Role and therapeutic implications in cancer.
Satthaporn S, Eremin O
J R Coll Surg Edinb · 2001 Jun · PMID 11478013
The potential to harness the effectiveness and specificity of the immune system underlies the growing interest in cancer immunotherapy. One such approach uses bone marrow-derived dendritic cells (DCs), phenotypically dis...
The potential to harness the effectiveness and specificity of the immune system underlies the growing interest in cancer immunotherapy. One such approach uses bone marrow-derived dendritic cells (DCs), phenotypically distinct and very potent antigen-presenting cells, to present tumour-associated antigens (TAAgs) and, thereby, generate tumour-specific immunity. Support for this strategy comes from animal studies that have demonstrated that DCs, when loaded ex vivo with tumour Ags or pulsed with peptides and administered to cancer-bearing hosts, can elicit T cell-mediated cancer destruction. These observations have led to clinical trials designed to investigate the immunological and clinical effects of Ag-pulsed DCs administered as a therapeutic vaccine to patients with cancer. In the design and conduct of such trials, important considerations include Ag selection, methods for introducing TAAgs into MHC class I and II processing pathways, methods for isolating and activating DCs, and route of administration. Although current DC-based vaccination methods are cumbersome and complex, promising preliminary results from clinical trials in patients with malignant lymphoma, melanoma, and prostate cancer suggest that immuno-therapeutic strategies, that take advantage of the unique properties of DCs, may ultimately prove both efficacious and widely applicable treatment in patients with cancer.
Surgical treatment of varicose veins.
Wolf B, Brittenden J
J R Coll Surg Edinb · 2001 Jun · PMID 11478012
Abstract loading — click title to view on PubMed.
Modern management of head injuries.
Flannery T, Buxton N
J R Coll Surg Edinb · 2001 Jun · PMID 11478011
Management of the head-injured patient is designed to prevent secondary injury and to provide the neurosurgeon with a live patient who has some hope of recovery. This review sets out the background essentials for the non...
Management of the head-injured patient is designed to prevent secondary injury and to provide the neurosurgeon with a live patient who has some hope of recovery. This review sets out the background essentials for the non-neurosurgeon dealing with the initial care of a head-injured patient.
The delivery of surgical cleft care in the United Kingdom.
Williams AC, Bearn D, Clark JD … +2 more , Shaw WC, Sandy JR
J R Coll Surg Edinb · 2001 Jun · PMID 11478010
BACKGROUND AND PURPOSE: A national survey of cleft teams was undertaken as part of the Clinical Standards Advisory Group investigation of the current status of cleft care in the United Kingdom (UK). METHODS: Fifty-seven...
BACKGROUND AND PURPOSE: A national survey of cleft teams was undertaken as part of the Clinical Standards Advisory Group investigation of the current status of cleft care in the United Kingdom (UK). METHODS: Fifty-seven cleft teams were identified, of which 90% responded to the survey. MAIN FINDINGS: Nine cleft teams had been established since 1992. Only one region, Northern Ireland, had a centralised cleft service and, despite 82% of teams having databases, only four were able to produce corroborated evidence of receiving at least 30 annual new referrals during 1995. There was a wide variation in the facilities provided by individual cleft teams--only six teams were able to provide all of the key facilities recommended by the Royal College of Surgeons Steering Group on cleft lip and palate. Facilities such as antenatal and neonatal counselling, protocols for record keeping and long-term treatment were similar for high and low volume teams. High volume teams were more likely to have established links with a full range of specialities including psychology, clinical genetics and paediatrics than low volume teams. CONCLUSION: A national survey of cleft services has demonstrated a need for reorganisation. This is now in process and once established will require continual monitoring and assessment.
Post-operative pain in needlescopic versus conventional laparoscopic cholecystectomy: a prospective randomised trial.
Look M, Chew SP, Tan YC … +6 more , Liew SE, Cheong DM, Tan JC, Wee SB, Teh CH, Low CH
J R Coll Surg Edinb · 2001 Jun · PMID 11478009
BACKGROUND: Needlescopic cholecystectomy (NC) utilises instruments and ports smaller than 3 mm in diameter compared with the 5 mm ones used in conventional laparoscopic cholecystectomy (LC). Post-operative pain control a...
BACKGROUND: Needlescopic cholecystectomy (NC) utilises instruments and ports smaller than 3 mm in diameter compared with the 5 mm ones used in conventional laparoscopic cholecystectomy (LC). Post-operative pain control and recovery has been thought to be superior in NC, when compared with historical controls with LC, but has not been proven in a prospective fashion. PATIENTS AND METHODS: A prospective randomised trial of NC versus LC for patients with symptomatic gallstone disease, with standardisation of post-operative analgesia and daily assessment of post-operative pain, using a 5-point visual analogue scale. RESULTS: There were 64 eligible patients randomised into NC (28) and LC (36). Four patients who had NC were converted to LC due to technical problems. Another three and six patients from the NC and LC groups, respectively, had conversion to open surgery. Post-operative pain scores were low in both groups. Mean pain scores for those with successful NC and LC were: 1.24 versus 1.43 for the day of operation (P = 0.49), 0.86 versus 0.83 for the first day post-operatively (P = 0.92) and 0.75 versus 0.81 for the second post-operative day (P = 0.87). The mean number of intra-muscular analgesic injections required were 0.76 versus 0.83 after NC and LC, respectively (P = 0.93). There were no significant differences between the two groups in the time taken to return to feeding, eating a normal diet and discharge from hospital. CONCLUSION: There is no advantage of NC over LC in terms of post-operative pain or recovery. Nevertheless, NC can be performed safely and expediently and has an excellent cosmetic outcome and high patient acceptability.
Direct optometrist referral of cataract patients into a pilot 'one-stop' cataract surgery facility.
Gaskell A, McLaughlin A, Young E … +1 more , McCristal K
J R Coll Surg Edinb · 2001 Jun · PMID 11478008
OBJECTIVES: To determine the feasibility of a) direct optometrist referral of patients with cataract, and b) combined assessment with same day cataract surgery ('one stop' cataract surgery). METHODS: Evaluation of 169 pa...
OBJECTIVES: To determine the feasibility of a) direct optometrist referral of patients with cataract, and b) combined assessment with same day cataract surgery ('one stop' cataract surgery). METHODS: Evaluation of 169 patients referred directly by optometrists into a pilot 'one stop' cataract surgery facility. RESULTS: Of 169 referrals, 160 patients (94.7%) were given confirmed appointments for the 'one stop' cataract service and 9 patients (5.3%) were appointed conventionally. Of 160 patients attending the 'one stop' cataract service, 154 patients (96.3%) underwent cataract surgery at the same visit, in 4 patients (2.5%) cataract surgery was indicated but deferred and in 2 patients (1.3%) cataract surgery was not indicated. The referral was supplemented with information regarding the patient's medical history forwarded by the general practitioner for 3 patients (1.8%). There were no systemic or sight-threatening complications. 151 patients (98.1%) achieved a visual acuity of 6/12 or better at a mean of 31 days post-operatively. CONCLUSION: Optometrists can accurately predict the need for cataract surgery and refer directly into a pilot 'one stop' cataract surgery facility, without the need for general practitioner involvement. 'One stop' cataract surgery is feasible; benefits to the patient include the abolition of the need to visit the general practitioner for consultation and referral, and the hospital for pre-assessment.
An audit of the management of the acute scrotum in children with Henoch-Schonlein Purpura.
Ioannides AS, Turnock R
J R Coll Surg Edinb · 2001 Apr · PMID 11329751
Many children with Henoch-Schonlein anaphylactoid purpura syndrome (HSAPS) who develop an acute scrotum have scrotal explorations to exclude torsion of the spermatic cord. However, the cause of the acute scrotum in the c...
Many children with Henoch-Schonlein anaphylactoid purpura syndrome (HSAPS) who develop an acute scrotum have scrotal explorations to exclude torsion of the spermatic cord. However, the cause of the acute scrotum in the context of HSAPS is known to be vasculitis and not torsion. The aim of this study, therefore, was to identify factors that underlie this practice. In a 10-year retrospective study of male patients admitted to a Children's Hospital with a diagnosis of HSAPS, 22 out of the 93 children identified (22/93 = 24%) had scrotal involvement. Three children (3/22 = 14%) were investigated radiologically, eight children (8/22 = 36%) had surgical exploration and none had testicular torsion. We believe that greater awareness of the syndrome and its clinical presentation amongst paediatric surgical staff could allow the adoption of a conservative approach in children with an unequivocal diagnosis of HSAPS provided such an approach is supported by high resolution colour Doppler sonography and a fully informed parental consent. Surgical exploration is indicated if the diagnosis of the syndrome is not beyond doubt and torsion cannot be excluded on clinical grounds.
Experience with a one-stop colorectal clinic.
Jones LS, Nicholson RW, Evans DA
J R Coll Surg Edinb · 2001 Apr · PMID 11329750
BACKGROUND AND OBJECTIVE: Colorectal services have traditionally been arranged for the convenience of hospitals rather than patients. This model is not ideal, particularly for minor interventions and diagnostic procedure...
BACKGROUND AND OBJECTIVE: Colorectal services have traditionally been arranged for the convenience of hospitals rather than patients. This model is not ideal, particularly for minor interventions and diagnostic procedures. In order to address this a one-stop colorectal clinic was set up. PATIENTS AND METHODS: Weekly clinics ran from 6.00 to 9.30 p.m. on Wednesdays for a period of 6 months. Patients with rectal bleeding, altered bowel habit, anorectal symptoms and those requesting screening advice were seen by a consultant or specialist registrar. Patients were asked to fill in a questionnaire at the end of their clinic attendance. RESULTS: 197 patients were seen in 17 clinics; 134 underwent proctoscopy, 72 had a rigid sigmoidoscopy and 85 had a flexible sigmoidoscopy carried out. Twenty-four patients subsequently had a barium enema and 3 were listed for colonoscopy. The main diagnosis was haemorrhoids (n = 104); 14 colorectal neoplasms were discovered (5 cancers and 9 polyps). During the study period the number of patients waiting for lower gastrointestinal endoscopy fell from 119 to 63; 2 months after ending the pilot scheme, the number had risen to 108. CONCLUSION: The clinic was found to have significantly improved patient care. The majority of patients were satisfied with an evening clinic. Flexible sigmoidoscopy without sedation was well tolerated and the ability to perform this at initial assessment had a marked effect on the number of patients awaiting lower gastrointestinal endoscopy.
Signs and symptoms of malignant parotid tumours: an objective assessment.
Wong DS
J R Coll Surg Edinb · 2001 Apr · PMID 11329749
BACKGROUND: The clinical features that may be associated with malignancy in parotid tumours are well known. Classical teaching dictates caution in their presence but this raises a false alarm in many cases. Formal studie...
BACKGROUND: The clinical features that may be associated with malignancy in parotid tumours are well known. Classical teaching dictates caution in their presence but this raises a false alarm in many cases. Formal studies looking at these features are few. The aim of this article was to study quantitatively those features that provide a better prediction of malignancy. METHODS: Clinical records of 186 consecutive patients treated for parotid tumours over a 12-year period were reviewed. Presence of suspicious clinical features and the final histology in each patient were noted. RESULTS: The overall pick-up rate for malignancy, based on clinical features alone, was around 30%. Palpable cervical lymph nodes, facial nerve palsy, deep fixation and rapid enlargement of the tumour were significant parameters indicative of malignancy (p = 0.000 for all 4 parameters, chi-squared test). The risk of malignancy increased when multiple parameters were present together at the same time. CONCLUSION: Clinical features remained the most important single modality identifying malignancy in patients with parotid tumours. The logistic regression model allowed for simple clinical prediction of malignancy with improved sensitivity and much better specificity.
Thyroid auto-antibodies, lymphocytic infiltration and the development of post-operative hypothyroidism following hemithyroidectomy for non-toxic nodular goitre.
Buchanan MA, Lee D
J R Coll Surg Edinb · 2001 Apr · PMID 11329748
BACKGROUND: Auto-immune thyroiditis, associated with detectable thyroid auto-antibodies (TAAs) and lymphocytic infiltration into the gland, is known to be associated with progressive development of hypothyroidism. This s...
BACKGROUND: Auto-immune thyroiditis, associated with detectable thyroid auto-antibodies (TAAs) and lymphocytic infiltration into the gland, is known to be associated with progressive development of hypothyroidism. This study examines those patients who required surgical treatment of non-toxic nodular goitre by hemithyroidectomy to determine whether the presence of TAAs in the circulation and/or lymphocytic infiltration of the gland resulted in a significant degree of post-operative hypothyroidism. METHOD: This was a prospective study, with data collected retrospectively. All patients operated on for thyroid disease in the unit over a 5-year period were documented, and those patients treated by hemithyroidectomy for non-toxic nodular goitre formed the study group. TAAs were measured, histology re-examined and patients followed up for at least 2 years to detect clinical or sub-clinical hypothyroidism. RESULTS: Of the 158 patients who comprised the study group, 38 (24.1%) developed hypothyroidism. Forty-one (25.9%) had circulating levels of TAAs, 31 of these (75.6%) having high levels. Of these 41 patients, 22 (53.7%) became hypothyroid. Twenty (64.5%) of the 31 patients with high levels of TAAs required post-operative thyroxine. Of the remaining 117 patients with no detectable TAAs, only 16 (13.7%) became hypothyroid. CONCLUSION: All patients requiring treatment by hemithyroidectomy should have circulating TAA measurements carried out pre-operatively. If positive, they should be followed up indefinitely because of the strong possibility (P < 0.001) of the development of hypothyroidism.
Surgical management of radial head fractures.
Parasa RB, Maffulli N
J R Coll Surg Edinb · 2001 Apr · PMID 11329747
OBJECTIVE: To compare the outcome of various surgical options exercised in the management of different types of radial head fractures. METHOD: A retrospective study of 29 patients with radial head fractures managed surgi...
OBJECTIVE: To compare the outcome of various surgical options exercised in the management of different types of radial head fractures. METHOD: A retrospective study of 29 patients with radial head fractures managed surgically was undertaken. Case notes were retrieved, and final assessment was performed through a telephone questionnaire. The results were analysed according to the classification of Wesley et al (1983), and compared with the patients' own rating. RESULTS: The best results were obtained in Mason type II fractures, followed by type III and type IV fractures. Comparing different operations, the best outcome was observed with screw fixation, followed by excision of the radial head, Kirschner wire fixation, partial excision, silastic implant, and plating, in that order. CONCLUSION: The less comminuted a radial head fracture is, the better the outcome. Screw fixation is to be preferred, if technically possible. Our method of outcome assessment closely reflected in patient satisfaction.
Current status of medicine in the USA: a personal perspective.
Fischer JE
J R Coll Surg Edinb · 2001 Apr · PMID 11329746
Abstract loading — click title to view on PubMed.
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