A simple guide to determine the magnification of radiographs and to improve the accuracy of preoperative templating.

Templates are used in the preoperative planning of many orthopaedic procedures. The magnification of the bones on preoperative radiographs can vary despite using standardised radiological techniques. Templates will give misleading measurements unless this magnification is quantified.

A comparison of the user-friendliness of hydroxyapatite and titanium ossicular prostheses.

Both hydroxyapatite (Ha) and titanium (Ti) are well-accepted alloplastic materials for ossicular prostheses. Many different designs of Ha and Ti prostheses are presently available. Fourteen surgeons of different seniority and surgical experience were asked to 'test-drive' four different types of ossicular prostheses in cadaveric temporal bones to investigate the user-friendliness of these protheses.

Adult-onset otitis media with effusion: results following ventilation tube insertion.

The outcome of otitis media with effusion (OME) in children is generally good. However, it is less clear in adults. All adult patients who had a ventilation tube inserted for OME at the Ipswich Hospital between 1996 and 1997 were studied.

Delayed spontaneous superior vena cava perforation associated with a SVC wallstent.

A patient was referred for superior vena cava (SVC) stenting prior to surgical biopsy of a mediastinal mass. A technically satisfactory insertion was followed 6 months later by cardiac tamponade with two legs of the Wallstent having perforated the wall of the SVC.

A rapidly expanding lesion in the neck: unusual presentation of Castleman's disease.

We report a painless but rapidly enlarging 9 cm x 4 cm lobulated hard neck mass. CT scanning suggested lymphoid tissue that was not confirmed by cytopathology. Histopathological analysis of the excision specimen detected Castleman's disease, extending to the resection margin.

Injury to the ligamentum teres. Mechanism, findings, and results of treatment.

In this article we discuss the role of the ligamentum teres in relation to the hip joint. The anatomy of the ligamentum teres is used to help with an understanding of the mechanism of the ligament's actions. This action and the modes of injury to the ligament are explored.

Facial paralysis with an inflammatory parotid mass.

Facial paralysis in association with a parotid mass is usually associated with a diagnosis of malignancy. Benign parotid neoplasms and inflammatory processes resulting in facial paralysis are extremely rare. This report describes such a case and highlights some of the difficulties surrounding the diagnosis and management of these cases.

Bedside tracer gas technique accurately predicts outcome in aspiration of spontaneous pneumothorax.

Background: There is no technique in general use that reliably predicts the outcome of manual aspiration of spontaneous pneumothorax. We have hypothesised that the absence of a pleural leak at the time of aspiration will identify a group of patients in whom immediate discharge is unlikely to be complicated by early lung re-collapse and have tested this hypothesis by using a simple bedside tracer gas technique.

Methods: Eighty four episodes of primary spontaneous pneumothorax and 35 episodes of secondary spontaneous pneumothorax were studied prospectively.

The effects of inadvertent intramuscular injection of BCG vaccine.

We report on a case of inadvertent intramuscular injection of BCG vaccine into an already tuberculin-sensitive individual which resulted in a severe and prolonged local reaction. There is no consensus on the best management of this complication, although in this case healing appeared to be hastened by anti-tuberculous chemotherapy.

Local treatments for cutaneous warts.

Background: Viral warts caused by the human papilloma virus represent one of the most common diseases of the skin. Any area of skin can be affected although the hands and feet are by far the commonest sites. A very wide range of local treatments are available.

Iatrogenic pneumothorax: marker gas technique for predicting outcome of manual aspiration.

Background: Although manual aspiration is used for treating pneumothorax, the post-aspiration radiograph may not be a reliable indicator of whether the pleural leak remains. We have previously shown that marker gas can identify an air leak in patients with spontaneous pneumothoraces.

Objective: This study examines whether a marker gas technique can be safely used to manage patients with iatrogenic pneumothoraces.

The distress and risk assessment method (DRAM).

Our aim was to judge the influence of preoperative psychological disturbance on the outcome of lumbar discectomy. We evaluated 66 patients, before and after operation, using a self-administered questionnaire. Disability was assessed using the Oswestry disability index and psychological disturbance the Distress and Risk Assessment Method (DRAM) score.

Acute cauda equina syndrome caused by a gas-containing prolapsed intervertebral disk.

Gas production as a part of disk degeneration can occur, but it rarely causes clinical nerve compression syndromes. A rare case of gaseous degeneration in a prolapsed lumbar intervertebral disk causing acute cauda equina syndrome is described. Radiologic features and intraoperative findings are reported.

Non-invasive positive pressure ventilation for severe thoracic trauma.

A 35-year-old man was admitted to the intensive care unit (ICU) following a road traffic accident. He had sustained severe trauma to the left side of his chest, as well as other musculoskeletal injuries. After a short initial period of ventilation of the lungs via a tracheal tube, he was managed using a combination of continuous positive airway pressure and non-invasive positive pressure ventilation.

Diabetic patient education: determinants of success.

Education/empowerment is critical if successful self-management is to be achieved. All professional patient interactions have a learning component. Clinical outcomes in diabetes are as dependent on psycho-social factors or learned behaviour as on metabolic state or therapeutic interventions.

Ultracision: the harmonic scalpel and its possible uses in maxillofacial surgery.

We report on the potential uses and benefits of a new development in incisive technology. The harmonic scalpel uses high-frequency mechanical energy to offer the surgeon controlled and precise incision and haemostasis. Vessels up to 2 mm in diameter may be sealed by coaptation with the blade before division.

Hyperventilation: cause or effect?

A young person presenting with shortness of breath is common to the accident and emergency department. Usually this hyperventilation is anxiety related or a panic attack, but sometimes it can be caused by a serious underlying condition like pulmonary embolus. Acute shortness of breath in any patient should never be dismissed lightly.

Blindness following a diabetic foot infection: a variant to the 'eye-foot syndrome'?

Aims: The 'eye-foot syndrome' was initially described by Walsh et al. to highlight the important association of foot lesions in patients with diabetic retinopathy. We present a case of a 58-year-old patient with Type 2 diabetes mellitus who developed blindness following endogenous staphylococcal endophthalmitis from an infected foot ulcer.

Issues surrounding educational preparation for intensive care nursing in the 21st century.

Major changes in intensive care provision, nursing and nurse education over the last ten years mean that it is a crucial time to take a look at the effectiveness of the post-registration intensive care nursing course [ENB 100]. This article examines whether nurse education is able to meet the current and future challenges. A call for more research regarding the effects of nurse education courses on participants' clinical practice is advocated.

Management of severe postnasal haemorrhage: the Kingsley splint revisited.

Postnasal haemorrhage accompanying severe craniofacial trauma may have catastrophic consequences if not arrested promptly. The airway has usually been secured and the cervical spine stabilized, but apart from fluid replacement, other attempts to control haemorrhage in the resuscitation room of the accident and emergency department may be to no avail. We wish to draw attention to a simple device that was introduced over 100 years ago and which may rapidly aid haemostasis and prevent the onset of hypovolaemic shock.