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Annals of the Royal College of Surgeons of England

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https://www.readbyqxmd.com/read/29182003/modification-validation-and-implementation-of-a-protocol-for-post-thyroidectomy-hypocalcaemia
#1
T Stedman, P Chew, P Truran, C B Lim, S P Balasubramanian
Introduction The management of post-thyroidectomy hypocalcaemia should facilitate early discharge, and reduce risks of hypocalcaemia, readmission and treatment related hypercalcaemia. This paper describes the implementation, evaluation and revision a protocol for the optimal management of this condition. Methods Day 1 parathyroid hormone (PTH) measurements in addition to calcium measurements were commenced following review of the unit's outcomes and literature on post-thyroidectomy hypocalcaemia. Outcomes from a three-year cohort of patients undergoing thyroid surgery helped amend this protocol (revision 1) to reduce biochemical tests, stipulate the need, nature and dose of vitamin D/calcium supplements, and encourage early discharge...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29182002/acute-hand-injury-splinting-the-good-the-bad-and-the-ugly
#2
T Richards, R Clement, I Russell, D Newington
Injuries to the hand comprise 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. The initial assessment and management of hand injuries is usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In the Department of Orthopaedic Hand Surgery, Morriston Hospital, we regularly observe patients presenting to the specialist hand fracture clinics having had initial management that shows no appreciation for the treatment objectives or the safe positions for splinting...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29182001/surgical-resection-of-a-massive-primary-mediastinal-liposarcoma-with-cervical-extension
#3
H L Weaver, S D Preston, H H Wong, P Jani, A S Coonar
A 73-year-old man was referred for surgical excision of a massive mediastinal and cervical liposarcoma following neoadjuvant chemotherapy. Surgery was performed via a cervical incision, sternotomy and right posterolateral thoracotomy. The tumour arose from the oesophagus, which underwent extensive dissection and was oversewn with pleura after tumour resection. Histology confirmed a completely excised grade 2 de-differentiated liposarcoma with complete macroscopic excision. The patient made an excellent recovery...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29182000/colossal-pilomatrixoma
#4
G Beattie, C Tai, S Pinar Karakas, E Cham, O Idowu, S Kim
We describe the largest reported case of pilomatrixoma in the literature. While pilomatrixomas typically present as small soft-tissue nodules of the head, neck and upper extremities, they can also present as much larger masses in atypical locations. When they present in their usual size, pilomatrixomas have typical imaging features and can be correctly diagnosed with imaging studies before histological confirmation. Their clinical and imaging diagnosis become challenging when they are very large, as in our case...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29181999/the-effect-of-non-steroidal-anti-inflammatory-drugs-on-severity-of-acute-pancreatitis-and-pancreatic-necrosis
#5
K A Baxter, P H Pucher, D P Berry, H Elberm, M Abu-Hilal, G Marangoni, Zzr Hamady
Introduction Acute pancreatitis (AP) is a common emergency presentation and can be disabling. There is significant morbidity and mortality associated with AP, and it places a considerable burden on the healthcare system. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to have a protective effect in some elective contexts. This retrospective study aimed to evaluate the effect of NSAIDs on the course of AP and the severity of the disease. Methods A retrospective analysis was carried out of 324 patients admitted as an emergency with a diagnosis of AP to two UK hospitals...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29181998/a-technique-for-k-wire-assisted-closed-reduction-and-percutaneous-screw-fixation-of-phalangeal-fractures
#6
A Hannah, R Helm
No abstract text is available yet for this article.
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29181997/tension-band-wire-stabilisation-an-aid-to-femoral-intramedullary-nail-fixation
#7
A Hannah, A Bruce
No abstract text is available yet for this article.
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29181996/choledochal-cyst-of-the-proximal-cystic-duct-a-taxonomical-and-therapeutic-conundrum
#8
R Kilambi, A N Singh, K S Madhusudhan, P Das, S Pal
Isolated choledochal cysts involving the cystic duct are rare. We present a case of a choledochal cyst involving only the proximal cystic duct, and discuss the taxonomic and therapeutic challenges. There is a need for a clearly defined classification system for these cysts as they may be categorised as either type II or type VI cysts. The optimal treatment remains debatable, with some authors recommending a bilioenteric reconstruction owing to the wide cystic duct-bile duct junction. However, we suggest that a cholecystectomy should be performed with examination of the specimen and frozen section in case of any abnormality rather than upfront bile duct excision...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29181995/the-effect-of-rectal-washout-on-local-recurrence-following-rectal-cancer-surgery
#9
S R Moosvi, K Manley, J Hernon
Introduction Local recurrence after surgery for rectal cancer is associated with significant morbidity and debilitating symptoms. Intraoperative rectal washout has been linked to a reduction in local recurrence but there is no conclusive evidence. The aim of this study was to evaluate whether performing rectal washout had any effect on the incidence of local recurrence in patients undergoing anterior resection for rectal cancer in the context of the current surgical management. Methods A total of 395 consecutive patients who underwent anterior resection with or without rectal washout for rectal cancer between January 2003 and July 2009 at a high volume single institution were analysed retrospectively...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29181994/urachal-remnant-causing-umbilical-in-drawing-during-micturition
#10
A J Martin, L McDonald, M Gopal
The urachus is a vestigial remnant of the allantois, which is normally obliterated during fetal life to become the median umbilical ligament, which runs between the urinary bladder and umbilicus in adults. Failure of obliteration leaves a tubular urachal remnant, which may present with disease. We report a unique case of a urachal remnant causing umbilical pain and in-drawing on micturition in a nine-year-old boy. There was no urine discharge from the umbilicus and in-drawing did not occur on defecation. His urinary stream was normal...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29181993/-reverse-guide-wire-technique-for-placement-of-anterior-column-superior-pubic-ramus-screw-in-pelvis-and-acetabular-surgery
#11
T H Tosounidis, P V Giannoudis
No abstract text is available yet for this article.
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29181992/the-significance-of-the-pharyngeal-veins-during-carotid-endarterectomy-description-of-an-anatomical-triangle
#12
J Aldoori, V Mahadevan, M Aldoori
Injuries to the hypoglossal and vagus nerves are the most commonly reported injuries during carotid endarterectomy. While unilateral single nerve injury is usually well tolerated, bilateral or combined nerve injuries can pose a serious threat to life. This study aims to increase awareness of the inferior pharyngeal vein, which usually passes posterior to the internal carotid artery but sometimes crosses anterior to it. Injury to either or both hypoglossal and vagus nerves can occur during control of unexpected haemorrhage from the torn and retracted edges of the inferior pharyngeal vein...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29181991/chest-wall-resection-and-reconstruction-for-rosai-dorfman-disease-masquerading-as-a-chest-wall-sarcoma
#13
V Joshi, G Offer, C Richards, S Rathinam
Rosai-Dorfman disease (RDD) is a rare benign histiocytic proliferative disease that can present as a pseudotumour of soft tissue. We describe the first chest wall resection and reconstruction.
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29260897/coccydynia-could-age-trauma-and-body-mass-index-be-independent-prognostic-factors-for-outcomes-of-intervention
#14
P Kodumuri, S Raghuvanshi, R Bommireddy, Z Klezl
Introduction The aetiology of coccydynia can be multifactorial, with several associated factors such as obesity, female gender and low mood. The long-term results of operative interventions, such as manipulation under anaesthesia and coccygectomy are variable, ranging from 63-90%. Materials and methods Our aim was to identify whether age, trauma and body mass index (BMI) were independent prognostic factors in coccydynia treatment. All patients who presented to the Royal Derby Hospital with a primary diagnosis of coccydynia between January 2011 and January 2015 who had injections, manipulation under anaesthesia or coccygectomy were included...
January 2018: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29260896/the-surgical-personality-does-it-exist
#15
Matthew Whitaker
Introduction This study aims to answer the question of whether surgeons have different personalities to non-surgeons. Methods Members of the Royal College of Surgeons of England were sent an email survey containing 50 standard questions from the Five Factor personality assessment, which scores each respondent in five key personality traits (conscientiousness, agreeableness, neuroticism, openness, extroversion). Results were analysed and compared with a population-level data set from a survey conducted by the BBC...
January 2018: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29260895/surgical-personae
#16
Tim Lane
No abstract text is available yet for this article.
January 2018: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29046083/variable-life-adjusted-display-methodology-for-continuous-performance-monitoring-of-carotid-endarterectomy
#17
G Kuhan, D P McCollum, P M Renwick, I C Chetter, P T McCollum
Introduction The aim of this study was to use variable life-adjusted display (VLAD) methodology to monitor performance of six vascular surgeons undertaking carotid endarterectomy in a single institution. Materials and methods This was a prospective study with continuous analysis. A risk score model to predict 30-day stroke or death for individual patients was developed from data collected from 839 patients from 1992 to 1999. The model was used to monitor performance of six surgeons from 2000 to 2009. Individual risk factors and 30-day outcomes were analysed and VLAD plots were created for the whole unit and for each surgeon...
January 2018: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29046077/cost-effectiveness-of-routine-imaging-of-suspected-appendicitis
#18
N D'Souza, M Marsden, S Bottomley, N Nagarajah, F Scutt, S Toh
Introduction The misdiagnosis of appendicitis and consequent removal of a normal appendix occurs in one in five patients in the UK. On the contrary, in healthcare systems with routine cross-sectional imaging of suspected appendicitis, the negative appendicectomy rate is around 5%. If we could reduce the rate in the UK to similar numbers, would this be cost effective? This study aimed to calculate the financial impact of negative appendicectomy at the Queen Alexandra Hospital and to explore whether a policy of routine imaging of such patients could reduce hospital costs...
January 2018: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29046075/portal-hypertension-and-chylous-ascites-complicating-acute-pancreatitis-the-therapeutic-value-of-portal-vein-stenting
#19
S Poo, T D Pencavel, J Jackson, L R Jiao
Chylous ascites as a consequence of acute pancreatitis is very rare. We present an unusual case of a 73-year-old man who developed refractory chylous ascites one month after an acute severe episode of gallstone pancreatitis, associated with portal hypertension. He was successfully treated with portal vein stenting, which has remained patent to date.
January 2018: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29046102/hip-fracture-surgery-in-mixed-use-emergency-theatres-is-the-infection-risk-increased-a-retrospective-matched-cohort-study
#20
S K Agarwal, A A Khan, M Solan, M Lemon
Introduction The National Institute of Health and Care Excellence recommends that people with hip fracture should have surgery on the day of, or the day after, admission. However, there remains unacceptable variation in performance around the country, with a range of 13-91% of patients meeting this target. Dedicated trauma lists have insufficient capacity in many hospitals. We occasionally employ a mixed-use emergency theatre to facilitate early surgery. Increased risk of infection has been raised as a concern owing to microbial surface contamination from a preceding unclean case and lack of laminar flow in these theatres...
November 2017: Annals of the Royal College of Surgeons of England
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