Radiography for head trauma in children: what guidelines should we use?

Objective: To audit the appropriateness of skill radiography in children attending an accident and emergency (A&E) department with head injuries.

Methods: 569 children presenting to a large teaching hospital A&E unit were retrospectively audited. The indications for radiography according to British published guidelines and American published guidelines were compared with the actual requests for radiography.

Changing patterns in accident and emergency attenders.

Objective: To investigate demographic changes in attenders at an accident and emergency (A&E) department.

Methods: Patients attending Leeds General Infirmary A&E department in 1990 were compared with those attending in 1993 and 1994. Internal quality control suggested that 99% of patients were correctly registered for details of method of arrival, age, and departure (admission/discharge).

Rules for collection of clinical data: the eight Rs.

Many reports in medical journals give advice on statistical analysis of data collected in clinical studies. The terms used are statistical, and clinicians often ponder how their data stand up to these analyses. Eight simple, easy to remember words are suggested that will help clinicians both to interpret their own data and to assess the accuracy of presented or published data.

Lyell's syndrome on a burns unit.

Two cases of Lyell's syndrome (toxic epidermal necrolysis) managed on a burn unit are presented. The various methods of management are discussed, and the arguments for treating this life-threatening condition on an intensive care burn unit are analysed.

The hit and miss of ISS and TRISS. Yorkshire Trauma Audit Group.

Objective: To measure interobserver variation in recording injury from case notes and its effect on calculating injury severity scores (ISS) from identical data and predicting probabilities of survival by using the combined trauma and injury severity score (TRISS).

Design: Observer variation study using injury severity scoring and subsequent calculation of probability of survival based on combined trauma and injury severity scores.

Subjects: 16 patients with a range of injury severity scores, and 15 observers.

Radiography for back pain presenting to accident and emergency departments.

In order to determine the relevance of radiographs of the lumbar spine in an A&E department 225 consecutive patients presenting in a 6-month period with acute back pain were studied. An analysis of the number of radiographs performed and their association with particular factors in the history and examination of the patient was performed. A total of 108 patients had radiographs (48%), with a total of seven fractures (6% of radiographs).

Is iliac node clearance necessary for stage II melanoma?

In a retrospective review (1970-1983), survival following block dissection of the groin was compared in two groups with clinical stage II melanoma. Twenty patients under one surgeon had ilioinguinal (high) block dissection, and 22 patients under another surgeon had inguinal (low) block dissection. The high block 5-year survival was 40 percent, and the low block 5-year survival was 35 percent.

Fractures of the body of the hamate.

Eight cases of fracture of the body of the hamate are presented, with descriptions of the injury and management. This fracture may be considerably more common than indicated by standard texts and previous published reports.

The use of the lateral arm flap in upper limb surgery.

Twenty patients who had had upper limb reconstruction using the lateral arm free microvascular flap are reviewed. The size of the flap, modifications to the flap, and complications were documented. There was one flap failure, and nine flaps required surgical thinning at a second procedure.

Further experience with the lateral arm free flap.

Our experience with the lateral arm free flap over the last 7 years was reviewed in detail, placing emphasis on the clinical aspects and modifications of the flap. A total of 150 patients have undergone reconstructive procedures with the flap for small to medium-sized defects. This included 18 split flaps, 11 osteocutaneous flaps, 6 with vascularized triceps tendon, 5 neurosensory flaps, and 5 fascia-fat flaps.

Adequacy of general practitioners' premises for minor surgery.

Objective: Assessment of facilities for minor surgery in general practitioners' premises.

Design: Independent inspection of premises and equipment.

Setting: Large urban district.

Upper gastro-intestinal complications in major head and neck surgery.

The recovery of patients from major head and neck surgery can be compromised by severe upper gastro-intestinal complications. We present two cases with such problems and discuss the rationale for our current management of prophylaxis.

Tissue expansion technique and the transposition flap.

A simple clinical guide is provided for calculation of the size of tissue expander necessary for any given defect. The use of an expanded transposition flap is demonstrated and its advantages expounded.

Tissue expansion: a unit review of non-scalp, non-breast expansion.

The results in 76 tissue expansions of sites other than the breast and scalp in 56 patients are presented. The overall failure rate was 12%, being particularly high in the arm (31%) and low in the leg (0%). Details of the technique used and their relevance to success are discussed.

A new surgical approach to exomphalos.

This report describes the use of tissue expansion for late reconstruction of giant exomphalos. An unexpected advantage was reconstruction of the anterior rectus sheath using the posterior capsule formed by the tissue expanders.

Protecting the exposed skin graft--the Norwich cage.

A simple method of protecting an exposed skin graft is presented. It is cheap, easy to use, and applicable to most sites of the body, even in areas with contours that might otherwise be thought difficult to protect.

Malignant melanomas of eyelid skin.

Four cases of malignant melanoma of eyelid skin are reported. Management of the condition is discussed, with a review of the literature. The conclusions lead us to recommend wide surgical excision for those melanomas arising on the lash margins.

Full thickness grafts taken from the plantar instep for syndactyly release.

Thirteen digital clefts (eight patients) were reviewed in which full-thickness plantar instep skin was used in syndactyly release. The results are presented, emphasising the good colour match of plantar instep skin with digital skin. There was a surprising lack of morbidity in the thirteen donor sites.