Linear stapled haemorrhoidectomy-an alternative to standard haemorrhoidectomy?

Objective: To evaluate in a pilot study a new haemorrhoidectomy technique involving the use of a linear stapling device.

Patients And Methods: Twenty consecutive unselected patients (12 male, eight female; median age 64 years, range 40-81 years) underwent haemorrhoidectomy using the new technique. Fifteen also underwent pre- and post-operative endoanal ultrasound to assess the anal sphincter complex.

External oblique aponeurosis nerve entrapment as a cause of groin pain in the athlete.

Background: Groin pain in sportsmen is a common management problem. The results of surgical exploration in 25 male athletes presenting with groin pain are described.

Methods: All patients had had failed non-operative management.

Case studies in therapeutics: warfarin resistance and inefficacy in a man with recurrent thromboembolism, and anticoagulant-associated priapism.

A 52 year-old male unemployed labourer was referred because of recurrent thromboembolism. An episode of thrombophlebitis migrans 3 months earlier had been followed by a pulmonary embolus a week later, and then a deep vein thrombosis despite apparently adequate anticoagulant therapy with warfarin 10 mg daily (INRs between 2 and 4). For 9 years he had suffered from hypertension for which he took lisinopril 2.

Drug allergy: fact or fiction?

From our clinical practice, it was apparent that patients often reported drug allergies without a substantiating history. A prospective study over six months was undertaken to examine the reporting of drug allergies by hospital patients. Based on the history, allergic reactions were triaged into one of three categories: high probability of an allergic reaction, low probability of an allergic reaction, and uncertain, where the history was incomplete or unclear.

Isoflurane for sedation in a case of congenital myasthenia gravis.

We describe the use of isoflurane for the management of a 3-yr-old boy with congenital myasthenia gravis who required ventilation for pneumonia. While in the intensive care unit he was sedated with isoflurane for 5 days (81 MAC-h). This provided a safe, easily controllable method of sedation which avoided the use of neuromuscular blocking agents and appeared to have no significant side effects during use.

Exploration of the common bile duct for stones: the influence of the flexible choledochoscope and perioperative antibiotic prophylaxis.

A retrospective study of 110 patients, out of a total of 743 open cholecystectomies, who have undergone common bile duct (CBD) exploration for stones between 1985 and 1990. CBD exploration was performed in the presence of abnormal peroperative cholangiogram in 86 (78%) patients. The remaining 24 patients were known to have either an abnormal preoperative ERCP or palpable ductal stones at the time of surgery.

A laboratory investigation into cements used to retain orthodontic bands.

A laboratory study is presented where a technique of band retention testing is characterized. A glass polyalkenoate and a zinc phosphate cement were evaluated for band retention under simulated conditions of mechanical stress. In the absence of mechanical and other stresses there was no difference in the two cements for band retention.

Delayed presentation of an extradural abscess complicating thoracic extradural analgesia.

Extradural abscess is a rare but recognized complication of extradural anaesthesia. Previous reports have been associated with a short time interval between extradural catheterization and presentation. We report a patient with rheumatoid arthritis, receiving steroid therapy, in whom an extradural abscess did not present until 23 days after the insertion of a thoracic extradural catheter to provide postoperative analgesia.

A new era in outpatients'.

In reply to the article and letters about outpatients (Nursing Standard June 19 and July 3), I must make a point that not all outpatients' departments are the same.

Effect of bilirubin on uricase-peroxidase coupled reactions. Implications for urate measurement in clinical samples and external quality assessment schemes.

Methods for the determination of serum urate which employ the uricase-peroxidase reaction may suffer interference from concentrations of bilirubin which can be found in relatively mild jaundice. Such concentrations of bilirubin are also frequently present in sera distributed as part of an external quality assessment scheme and, for this reason, laboratories should be particularly careful not to recalibrate their urate assays to attempt to achieve results closer to the consensus mean.

Complicated peptic ulcer disease in childhood: an overlooked diagnosis.

Primary peptic ulceration is no longer regarded as a rare disease of childhood, but its exact incidence and pathogenesis remain debatable. We report the case of an 11-year-old boy, who presented with a perforated primary gastric ulcer, a rare complication in this age group.

Massive haemorrhage in pancreatitis.

Massive haemorrhage in pancreatitis is a very rare complication of pancreatitis but it is the most rapidly lethal, haemorrhage being the major cause of death in more than half of the fatal cases. We present three patients who illustrate this rare complication in its diversity of presentation, and advise that doctors should have a keen clinical awareness of this condition if there is to be an effective and expeditious management. An understanding of the condition, coupled with immediate treatment, using embolisation or laparotomy with direct ligation of the bleeding vessel, can be lifesaving.

Thrombosed sapheno-varix: an important and unusual differential diagnosis of strangulated femoral hernia.

An incarcerated femoral hernia often requires prompt operative management to decrease the risk of bowel strangulation, perforation and death from peritonitis. We present a case of a 60-year-old man who had a clinically irreducible right femoral hernia, and in whom a Richter's hernia could not be excluded. He was found to have a thrombosed sapheno-varix with no evidence of a femoral hernia.

Mycotic pseudoaneurysm of the descending thoracic aorta associated with vertebral osteomyelitis.

A patient with osteomyelitis of the lower thoracic spine is reported in whom computed tomography (CT) revealed a large false aneurysm of the descending aorta. Useful radiological signs of the diagnosis are described, namely a thin aneurysm wall, a multilobulated margin and deformity of the aneurysm by adjacent vascular and osseous structures. Mycotic aneurysms of the aorta have a high mortality and the CT demonstration of a pseudoaneurysm has a vital role in management.

Perianal Paget's disease. Report of three cases.

Three cases of perianal Paget's disease are presented. Clinically, three patients had a chronic irritating perianal rash resistant to hydrocortisone cream. One patient had an underlying rectal adenocarcinoma.