Surgical complications and implications of external fixation of pelvic fractures.

The application of a pelvic external fixator can be a vital stage in the management of patients with severe pelvic fractures, either as part of the resuscitation phase or as definitive treatment. This paper shows the complication rate of pelvic external fixation to be 47 per cent. This high rate increases the morbidity associated with the fracture, and may also interfere with the definitive management.

Executive function in first-episode schizophrenia.

Background: We tested the hypothesis that schizophrenia is primarily a frontostriatal disorder by examining executive function in first-episode patients. Previous studies have shown either equal decrements in many cognitive domains or specific deficits in memory. Such studies have grouped test results or have used few executive measures, thus, possibly losing information.

A palliative care education model for the hospital setting.

This paper describes an integrated, needs-led palliative care education model for qualified nurses, developed by collaboration between a hospital-based palliative care team of a large NHS Trust and a specialist palliative care unit, in order to serve its common healthcare users. The aim of this model was to develop the knowledge and skills gained through clinical practice and ongoing education in order to achieve a basic level of expertise, and to enhance communication and collaboration between the hospital and community-based nursing services throughout the geographical area for for patients requiring palliative care.

Should relatives be allowed in the resuscitation room?

Objective: To assess doctors' and nurses' views on the presence of relatives in the resuscitation room during cardiac arrest or major trauma.

Design: Questionnaires were sent to accident and emergency (A&E) nurses and doctors of all disciplines in a London teaching hospital. Recipients were asked if they would favour the presence of selected relatives in the resuscitation room and to give comments.

Severe skin loss after meningococcal septicaemia: complications in treatment.

Meningococcal septicaemia can lead to purpura fulminans with subsequent full thickness skin loss and deep muscle damage. The case reports on two infants who recovered from such a severe episode are used to describe post-septicaemic procedures and complications encountered in nursing care, psychological support and rehabilitation, with the main focus on surgery. Skin grafting is complicated by contaminated and contracting wound areas.

Ultrasound imaging in assessment of fractures of the orbital floor.

Twenty patients who had sustained facial trauma with clinical evidence of an orbital floor fracture were examined by ultrasound in a blinded prospective study to assess the utility of ultrasound in the diagnosis of orbital floor fractures. Ultrasound detected the presence of an orbital floor fracture with an overall accuracy of 86% and a sensitivity of 85% compared with computed tomography (CT) or direct surgical exploration of the orbital floor. This is lower than that quoted in previous reports.

Tropical aspects of viral hepatitis. Hepatitis C.

This paper reviews our current understanding of hepatitis C infection in tropical countries. Since its discovery in 1989, hepatitis C has been recognized as an important disease in many tropical countries. In Egypt the prevalence in some sections of the population may-exceed 20%.

Current surgical treatment of Dupuytren's disease.

The practice of surgery for Dupuytren's contracture is changing. Most surgery can be carried out under regional or local anaesthesia on a day case basis. Although the commonest surgery performed is partial fasciectomy, there is more a polarisation developing with minimal surgery (e.

Evidence that the HLA DQA1*03 allele confers protection from chronic HCV-infection in Northern European Caucasoids.

In the search for factors which may influence susceptibility to and outcome from chronic hepatitis C virus (HCV) infection, few studies have considered the influence of host genes. In the present investigation we have performed HLA DRB1, DQA1, DQB1, and DPB1 genotyping on 104 northern European patients with chronic HCV infection and 177 racially and geographically matched controls. Three HLA class II alleles, DRB1*0403, DQA1*03, and DQB1*0302 were present at a significantly lower frequency in patients compared with controls (4.

Seroprevalence of hepatitis B and C virus in two institutions caring for mentally handicapped adults.

Hepatitis B virus infection is common in institutions caring for the mentally handicapped. Hepatitis B virus and hepatitis C virus share routes of transmission but the prevalence of hepatitis C virus infection in this population is unknown. We have tested 101 patients from two institutions in South-East England caring for adults with mental handicap for the presence of hepatitis C antibody, hepatitis B core antibody, and if necessary hepatitis B surface antigen.

Thrombosis within an external jugular venous aneurysm.

Jugular plebectasia is rare, and most patients present in childhood. We describe a thrombotic episode within an external jugular venous aneurysm in an adult. This has not previously been described in the medical literature.

Intravenous infusion of prostacyclin to prevent platelet thrombus during microvascular anastomoses.

Two cases are presented where the use of epoprostenol sodium (prostacyclin) was used intraoperatively to prevent platelet thrombus during arterial microvascular anastomoses. Both patients required a free muscle transfer at an unfavourable time following injury when platelet thrombus formation was a significant risk.

Dermasorb versus Jelonet in patients with burns skin graft donor sites.

A prospective and randomized trial that compares Jelonet (Smith & Nephew PLC, London, England) with a new hydrocolloid dressing, Dermasorb (Convatec Ltd., Clwyd, United Kingdom), is presented. The dressings were applied on contiguous donor sites in 21 patients that required skin grafting for burn wounds.

Restricted mandibular opening complicating intraoral galeal flap reconstruction and radiotherapy: case report.

Despite many advantages over musculocutaneous and free flaps, galeal flaps are seldom used intraorally by the head and neck surgeon. The literature reveals little in the way of complications of such flaps. A case is reported in which a temporoparietal galeal flap used in reconstruction after resection of an intraoral squamous cell carcinoma, followed by a course of radiotherapy, led to postoperative restriction of mandibular opening.

Haemophilus aphrophilus discitis and vertebral osteomyelitis.

An unusual case of discitis and vertebral osteomyelitis due to Haemophilus aphrophilus is described. Infections due to this organism have usually responded to treatment with beta-lactam antibiotics. However, our isolate was resistant to third-generation cephalosporins which has not been reported previously in the world literature.

Bilateral parotid MALT lymphoma and Sjögren's syndrome.

A patient with Sjögren's syndrome who developed bilateral parotid lymphoma is described. The management is discussed emphasising difficult aspects of the diagnosis and treatment.