Case report: characteristic ultrasonographic appearance of a large renal oncocytoma.

The sonographic appearance of a large renal oncocytoma is described. The 'spoke-wheel' of hypoechoic radiating bands within the tumour was found to correlate closely with other imaging modalities and the histopathological appearance of the surgical specimen. This characteristic sonographic picture, which appears to be a feature of size, enabled a confident pre-operative diagnosis to be made.

Medial fasciocutaneous flap of thigh for release of post-burn groin contractures.

Post-burn groin contractures, though uncommon, cause some patients distressing symptoms which are difficult to treat. Recurrence of contracture and symptoms is common and multiple operations are often required to control symptoms. We describe the use of the medial thigh fasciocutaneous flap for release of these contractures.

Gentamicin impregnated polymethylmethacrylate (PMMA) beads in the treatment of primary chronic osteomyelitis of the mandible.

Primary chronic osteomyelitis (chronic diffuse sclerosing osteomyelitis) of the mandible is an uncommon condition, probably arising as a consequence of infection with bacteria of low virulence, in which bone deposition rather than bone resorption occurs. These bacteria are most likely derived from skin or oral mucosa gaining access to bone from the periodontium or through the circulation. Furthermore, delayed hypersensitivity and ischaemic changes within bone may contribute to the inflammatory response, which once initiated is very difficult to eradicate.

Problems in the orthodontic management of orthognathic cases.

The planning and management of orthodontic treatment for patients requiring surgery is considered in the light of a variety of problems that occur commonly, but have not received much attention in the literature. These problems can be categorized into dental, skeletal, and soft tissue varieties, and some cases are presented in illustration. The occasional need for compromise in treatment planning is suggested and the limitations of an excessive dependence on cephalometrics are discussed.

Giant enterocystoma within an infant's tongue.

A rare developmental cyst within the tongue and submandibular triangle of a male infant containing heterotopic gastric and intestinal epithelium (enterocystoma) is described and its derivation discussed. This cyst was of such a size as to cause feeding difficulties and partial airway obstruction during sleep. Following C.

Through-knee amputation in high-risk patients with vascular disease: indications, complications and rehabilitation.

During a 10-year period 104 patients (mean age 72 years) had 106 through-knee amputations. Indications for surgery were: limb gangrene, 67 (64 per cent); ischaemic ulceration, 22 (21 per cent); rest pain, 9; knee contractures, 6. Thirty patients had had previous unsuccessful vascular reconstructive surgery and five had had a failed femoral embolectomy.

A clinical and biomechanical assessment of the Hall surgical miniplate system.

The Hall surgical miniplating system has been evaluated for use in maxillofacial trauma and orthognathic surgery. The biomechanical characteristics of the plates have been examined and experience gained, using 53 plates, in 25 patients is presented. The feature which distinguishes these plates is the narrow bridge between paired screw platforms.

Horizontal-T genioplasty--(a modified technique for the broad or asymmetrical chin).

A modified technique for genioplasty is described. A horizontal, single-slice of bone is sectioned from the inferior border of the chin, with preservation of the lingual soft tissue attachment, in the conventional manner. This is divided sagittally into three segments, which are not necessarily equal, and are then repositioned in the shape of a horizontal 'T'.

Effort thrombosis in an American football player.

A case of lower limb venous thrombosis occurring in a young male after playing American football is described. The features are compared to the more widely recognized effort thrombosis of the upper limb veins. The possibility of effort thrombosis needs to be considered in athletes presenting with leg injuries.

The timing of amputation for lower limb trauma.

We reviewed 35 patients who had an amputation following the failure of treatment for severe lower limb trauma. Seven of the amputations were for ischaemia, within one month of injury; 13 were between one month and one year for infection complicating loss of wound cover in un-united fractures; and 15 were later than one year after injury, mainly for infected non-union. The latter group of patients had had an average of 12 operations and 50 months of treatment, including eight months in hospital.

Early-onset neonatal pneumococcal sepsis in siblings.

The case of a woman who in two successive pregnancies produced premature infants affected by early-onset Streptococcus pneumoniae type 8 sepsis is described. Low maternal levels of pneumococcal IgG antibodies were demonstrated after the second delivery, and vaccination with 'Pneumovax' produced a rise in antibody levels. Attention is drawn to the similarity between early-onset pneumococcal neonatal sepsis and group B streptococcal sepsis.

Objective assessment in dementia: automated psychometric tests and the P3.

Event-related potentials have been shown to be closely correlated with cognitive functioning and it has been suggested that one such potential, the P3, can act as an objective and sensitive measure of the degree of dementia. The P3 is no longer thought of as a diagnostic tool in dementia; however, longitudinal changes in the P3 latency can be used to follow the course of a dementing illness or to assess effects of therapy. It is possible that the measurement of P3 latency may prove useful in the selection of patients with early dementia.

Parapharyngeal neurilemmomas.

Parapharyngeal neurilemmomas are uncommon benign tumours. Two patients are reported with one tumour arising from the vagus and the other from the hypoglossal nerve. Access to the vagal tumour was accomplished with the aid of an osteotomy at the angle of the mandible.

Dysplasia and carcinoma in the rectal stump of total colitics who have undergone colectomy and ileo-rectal anastomosis.

From a group of 374 patients with ulcerative colitis who underwent colectomy and ileo-rectal anastomosis between 1952 and 1976, 104 presented for follow-up rectal biopsies over a 5 year period to 1986. These patients have been followed for an average of 28 years since the onset of the disease (range 11-56) and provide a unique model for the study of the development of carcinoma in colitis. A total of 443 biopsies was examined and epithelial morphology assessed according to the classification of Riddell et al.

Ganglion of the temporomandibular joint. Case report and literature survey.

A case report of a female patient presenting with a painless lump related to the right temporomandibular joint is described. The swelling was surgically excised and the histopathological examination of the specimen showed a very clear resemblance to a ganglion of the synovial membrane. The literature of this rare entity is reviewed.

The repair of defects in the head and neck region with the latissimus dorsi myocutaneous flap.

There are many different flaps available for head and neck reconstruction. The latissimus dorsi myocutaneous flap has been widely used in this unit on 80 occasions in the past three years, both as a pedicled and as a free microvascular flap following the excision of head and neck malignancy, the commonest pathology being intraoral squamous cell carcinoma. There were nine cases of complete or substantial flap loss requiring a further reconstructive procedure.

Beau's lines following hand trauma.

Six cases are described of Beau's lines (transverse grooves in the fingernails) developing after injuries to the hand involving damage to nerves and flexor tendons. The literature is reviewed.

Squamous cell carcinoma arising in an odontogenic cyst.

Squamous cell carcinoma arising is an odontogenic cyst is rare, Eversole finding 36 cases in his review of the literature in 1975. Since then, a further 10 have been recorded in the English literature. We now report another case and describe its management.

A new apicectomy retractor.

A retractor designed to give a wide field of vision and surgical access to apicectomy sites in the upper anterior region of the maxilla is described.

A review of the first 12 months of a hand clinic.

The potential problems faced on setting up a hand clinic and how they may be overcome are discussed. In its first 12 months there were 199 new referrals over 50% of which were either lacerations, fingertip injuries or fractures. The management of these cases is discussed.