This article examines the career of Frederick John Knox (1794-1873), who was the younger brother and erstwhile assistant of Robert Knox the anatomist. He was licensed by the Royal College of Surgeons of Edinburgh in 1831...This article examines the career of Frederick John Knox (1794-1873), who was the younger brother and erstwhile assistant of Robert Knox the anatomist. He was licensed by the Royal College of Surgeons of Edinburgh in 1831, and in 1840 he emigrated with his wife and family to New Zealand, becoming a significant figure in the scientific community of the infant settlement of Wellington.
UNLABELLED: A femoral hernia accounts for approximately 5-10% of all groin hernias in adults. Misdiagnosis in children, in whom the condition is rare, has been well recognised and documented. The aim of this study was to...UNLABELLED: A femoral hernia accounts for approximately 5-10% of all groin hernias in adults. Misdiagnosis in children, in whom the condition is rare, has been well recognised and documented. The aim of this study was to assess the accuracy of diagnosis in an adult population. METHODS: An analysis of 379 patients with a groin hernia, presenting electively to a University Department of Surgery and entered into a prospective clinical trial. RESULTS: A femoral hernia was confirmed at operation in 12 (3%) patients while a further 4 had a preoperative diagnosis of a femoral hernia. The correct diagnosis of a femoral hernia was made in only 3 cases by general practitioners and in only 6 by surgical staff of all grades. CONCLUSION: These data suggest that medical staff of all grades may be poor at diagnosing a femoral hernia and a change in the way we are taught to differentiate between femoral and inguinal hernia needs to be considered.
Rivkind AI, Zvulunov A, Schwartz AJ
… +2 more, Reissman P, Belzberg H
J R Coll Surg Edinb
· 2001 Apr · PMID 11329739
Injuries to the eosophagus are notoriously difficult to diagnose pre-operatively. Patients with such injuries usually will not have pre-operative signs and symptoms to suggest the presence of this type of injury. These i...Injuries to the eosophagus are notoriously difficult to diagnose pre-operatively. Patients with such injuries usually will not have pre-operative signs and symptoms to suggest the presence of this type of injury. These injuries require a high index of suspicion, appreciation of the presence of injuries to adjacent structures, and an understanding that the clinical and radiological findings may evolve over a period of time. We describe a child with a rare presentation of an acute traumatic esophageal spinal fistula due to a bullet wound. This complicated injury required a variety of diagnostic modalities, including contrast radiography, multiple computerised tomography (CT) scans and operative assessments to make the definitive diagnosis.
Torsion of an intraabdominal testis is a rare cause of acute abdominal pain. With a history of undescended testis, it is difficult to establish the diagnosis and to exclude other emergency abdominal conditions without a...Torsion of an intraabdominal testis is a rare cause of acute abdominal pain. With a history of undescended testis, it is difficult to establish the diagnosis and to exclude other emergency abdominal conditions without a laparotomy. The following case report illustrates the usefulness of laparoscopy as a diagnostic as well as a therapeutic tool in such a condition.
Basnyat PS, Jones DA, Morgan RJ
… +2 more, Davies CJ, Foster ME
J R Coll Surg Edinb
· 2001 Apr · PMID 11329737
We report an unusual case of splenogonal fusion in a 10-year-old boy with an undescended left testis. He suffered from congenital limb defects, a known association with splenogonadal fusion, and had originally been admit...We report an unusual case of splenogonal fusion in a 10-year-old boy with an undescended left testis. He suffered from congenital limb defects, a known association with splenogonadal fusion, and had originally been admitted for orchidopexy.
Truly informed consent is a difficult thing to achieve! Patients are not healthy volunteers and their vulnerability challenges their ability to assess the risk/benefit of health choices. In this paper we consider some or...Truly informed consent is a difficult thing to achieve! Patients are not healthy volunteers and their vulnerability challenges their ability to assess the risk/benefit of health choices. In this paper we consider some or the issues surrounding this important aspect of modern practice, and offer some suggestions on how to improve the process, with the goal of increasing participation in clinical research, and enhancing patients' confidence in their medical advisors.
Dendritic cells (DCs) are potent antigen presenting cells (APCs) that possess the ability to stimulate naïve T cells. They comprise a system of leukocytes widely distributed in all tissues, especially in those that provi...Dendritic cells (DCs) are potent antigen presenting cells (APCs) that possess the ability to stimulate naïve T cells. They comprise a system of leukocytes widely distributed in all tissues, especially in those that provide an environmental interface. DCs posses a heterogeneous haemopoietic lineage, in that subsets from different tissues have been shown to posses a differential morphology, phenotype and function. The ability to stimulate naïve T cell proliferation appears to be shared between these various DC subsets. It has been suggested that the so-called myeloid and lymphoid-derived subsets of DCs perform specific stimulatory or tolerogenic function, respectively. DCs are derived from bone marrow progenitors and circulate in the blood as immature precursors prior to migration into peripheral tissues. Within different tissues, DCs differentiate and become active in the taking up and processing of antigens (Ags), and their subsequent presentation on the cell surface linked to major histocompatibility (MHC) molecules. Upon appropriate stimulation, DCs undergo further maturation and migrate to secondary lymphoid tissues where they present Ag to T cells and induce an immune response. DCs are receiving increasing scientific and clinical interest due to their key role in anti-cancer host responses and potential use as biological adjuvants in tumour vaccines, as well as their involvement in the immunobiology of tolerance and autoimmunity.
An 8-year-old boy presented with inability to extend his fingers. Examination revealed congenital hypoplasia of the extensor tendons. He was treated with tendon transfers. We present a review of the literature and manage...An 8-year-old boy presented with inability to extend his fingers. Examination revealed congenital hypoplasia of the extensor tendons. He was treated with tendon transfers. We present a review of the literature and management of such cases.
Analysis of the material written in the two manuscript volumes known as the "Old" and "New" Knox Catalogues has revealed that most of their contents are in the hand of Frederick Knox, younger brother of Dr Robert Knox. F...Analysis of the material written in the two manuscript volumes known as the "Old" and "New" Knox Catalogues has revealed that most of their contents are in the hand of Frederick Knox, younger brother of Dr Robert Knox. Frederick was employed by Dr Knox as his research assistant, and prepared detailed lists of the items in his brother's museum collection. He also dissected and prepared human and non-human specimens, many of which were described by Dr Knox in his numerous publications. As relatively little is known about Frederick Knox, this seemed a timely opportunity to evaluate his contribution to Knox's anatomy class in the extra-mural school. When in due course Dr Knox's success as a teacher of anatomy gradually declined, he decided to leave Edinburgh to pursue his career in London. It was at about this time that his brother Frederick also decided to leave Edinburgh to establish a new career for himself in the Antipodes. The present whereabouts of the majority of Knox's enormous teaching collection of anatomical preparations and his comparative anatomy collection are unknown, and suggestions are made as to their possible whereabouts.
Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients...Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.
Maxwell-Armstrong CA, Noorpuri BS, Haque SA
… +2 more, Baker DM, Lamerton AJ
J R Coll Surg Edinb
· 2001 Feb · PMID 11242741
BACKGROUND: Thoracic outlet compression syndrome is characterised by a variety of symptoms relating to compression of the neurovascular bundle. Though no one test is specific for the syndrome, relief of symptoms may be o...BACKGROUND: Thoracic outlet compression syndrome is characterised by a variety of symptoms relating to compression of the neurovascular bundle. Though no one test is specific for the syndrome, relief of symptoms may be obtained following surgery in up to 99% of cases. PATIENTS AND METHODS: The notes of 118 patients operated on in 126 operations by a single surgeon using a supraclavicular approach were reviewed. Symptoms, pre-operative investigations, and complications were all documented. Outcome at 6 weeks, 6, 12 and 24 months follow-up was also recorded. In addition, 61 patients were contacted by telephone, in order to assess current level of symptoms. RESULTS: Symptoms were predominantly motor, sensory or vasomotor, and were present for a mean of 19.6 months prior to surgery. Complications were rare, but included a pneumothorax requiring a chest drain (n = 1) and infraclavicular anaesthesia (n = 13). The mean duration of hospital stay was 2.1 days. At 6 weeks follow up, 86.5% of patients reported either an improvement, or complete resolution of their symptoms. Sixty-one patients were contactable, a mean of 55 months following decompression. Of these, 44 (72.1%) were either improved or asymptomatic. CONCLUSION: Decompression for thoracic outlet compression syndrome through a supraclavicular approach encompassing first rib resection leads to good long-term results with few complications.