Identifying the best therapy for chronic anal fissure.

Chronic anal fissure (CAF) is a painful tear or crack which occurs in the anoderm. The optimal algorithm of therapy for CAF is still debated. Lateral internal sphincterotomy (LIS) is a surgical treatment, considered as the 'gold standard' therapy for CAF.

Use of octenidine dihydrochloride in meticillin-resistant Staphylococcus aureus decolonisation regimens: a literature review.

Decolonisation of patients colonised with meticillin-resistant Staphylococcus aureus (MRSA) is one of the recommended methods for controlling MRSA in hospitals but there is a limited choice of agents that can be used. Octenidine dihydrochloride is a relatively new antiseptic that has been used for MRSA decolonisation in some countries. On reviewing available literature on its use for MRSA decolonisation, only four observational studies were found.

Tissue microarray technology in the routine assessment of HER-2 status in invasive breast cancer: a prospective study of the use of immunohistochemistry and fluorescence in situ hybridization.

Aims: To compare tissue microarray (TMA) and whole-section (WS) techniques in the routine assessment of HER-2 status in invasive breast cancer by immunohistochemistry and fluorescence in situ hybridization (FISH).

Methods And Results: HER-2 status was assessed prospectively in 106 consecutive cases of excised high-grade and/or node-positive breast carcinoma using both WS- and TMA-based techniques. Whole sections were assessed by immunohistochemistry with FISH being performed on equivocal cases (scoring 2+ on HercepTest) and randomly selected 3+ cases included for quality assurance.

Genitourinary medicine clinic and general practitioner contact: what do patients want?

Objectives: While genitourinary medicine (GUM) records have historically been kept separate from other medical data, patient information is increasingly shared across the NHS. There are advantages to this in GUM: GPs are increasingly involved in delivering targets for STI screening and sexual health services. We ascertained patient attitudes to proposals to routinely send clinic letters to GPs and to share GUM data on common IT systems.

Randomised trial of glutamine and selenium supplemented parenteral nutrition for critically ill patients. Protocol Version 9, 19 February 2007 known as SIGNET (Scottish Intensive care Glutamine or seleNium Evaluative Trial).

Background: Mortality rates in the Intensive Care Unit and subsequent hospital mortality rates in the UK remain high. Infections in Intensive Care are associated with a 2-3 times increased risk of death. It is thought that under conditions of severe metabolic stress glutamine becomes "conditionally essential".

Audit of Postal Test Kits in Edinburgh for Chlamydia trachomatis as an alternative to genitourinary medicine clinic attendance.

Our objective was to investigate whether Postal Test Kits (PTKs) for Chlamydia trachomatis in Edinburgh offer an alternative to genitourinary (GU) medicine clinic attendance. All PTKs returned in the Edinburgh area over a six-month period from August 2005 were audited. Data on age and previous access to GU medicine services were collected.

The treatment of pharyngeal gonorrhoea with a single oral dose of cefixime.

An audit of the efficacy treatment of pharyngeal gonorrhoea with a single oral dose of 400 mg of cefixime was undertaken; 83% of patients also received a single oral dose of azithromycin to treat possible concurrent anogenital chlamydial infection. Of the 54 patients studied, only one of 45 patients who attended for at least one test of cure had a positive culture seven days after treatment; the possibility of reinfection could not have been excluded. Two tests of cure were obtained from 18 patients.

Secondary perineal hernia following open abdominoperineal excision of the rectum: report of a case and review of the literature.

This is a case report of a 46-year-old man who presented with a painful perineal lump four months after abdominoperineal excision of the rectum (APER) with pre-operative radiotherapy and adjuvant chemotherapy. Perineal hernia (suspected clinically) was confirmed by magnetic resonance imaging, and the patient underwent open Permacol mesh repair via a perineal approach. Symptomatic perineal herniation after surgical resection is a rare phenomenon, and the approach to management remains challenging.

Audit of syphilis treatment, follow-up and contact-tracing rates.

An audit of diagnoses of syphilis infection managed at the Edinburgh genitourinary (GU) medicine clinic for the period 1 October 2001-31 October 2004. In all, 101 patients were identified as untreated carriers or contacts requiring treatment, partner notification and follow-up. Treatment rate was 100% in the audit population.

The detection of genital tract infection by Papanicolaou-stained tests.

A variety of cytological changes suggestive of genital tract infection may be noted during microscopy of a Papanicolaou-stained cervical smear. The dilemma faced by cytopathologists is whether or not to report suspicious changes to the clinician responsible for the woman's care. This review examines the effectiveness of Papanicolaou-smear microscopy in the diagnosis of the more common sexually transmitted infections, and aims to encourage debate on the reporting of suggestive cytological changes.

How many sexually transmitted infections (STIs) will we miss?--an algorithm to assess risk factors for STI.

A self-administered algorithm for the assessment of symptoms of, and risk factors for, sexually transmitted infection (STI) was developed. The algorithm was applied retrospectively to all cases of STI other than chlamydia diagnosed over a one-year period, to estimate the risk of missing STI diagnoses by its introduction. Three hundred and eighty-nine cases were identified, of whom 81 (21%) were asymptomatic.

Characteristics of younger and older men with urethral chlamydial infection.

This study examined some characteristics of male clinic attenders with urethral chlamydial infection. The prevalence of urethral chlamydial infection among heterosexual men (men who have sex with women [MSW]) was 446 (17%) of 2684 men. Men aged 16-34 years were more likely to have chlamydiae than older men with only casual partners (chi2 = 16.

Endobronchial ultrasound-guided fine-needle aspiration and liquid-based thin-layer cytology.

Background: Optimal management of patients with lung cancer requires accurate cell typing of tumours and staging at the time of diagnosis. Endobronchial ultrasound-guided lymph node aspiration as a method of diagnosing and staging lung cancer is a relatively new technique.

Aim: To report the use of liquid-based-thin-layer cytology for the processing and reporting of these specimens.

The tip of the iceberg: a giant pelvic atypical lipoma presenting as a sciatic hernia.

Background: This case report highlights two unusual surgical phenomena: lipoma-like well-differentiated liposarcomas and sciatic hernias. It illustrates the need to be aware that hernias may not always simply contain intra-abdominal viscera.

Case Presentation: A 36 year old woman presented with an expanding, yet reducible, right gluteal mass, indicative of a sciatic hernia.

Use of a temporary cohort ward as part of an intervention to reduce the incidence of meticillin-resistant Staphylococcus aureus in a vascular surgery ward.

This article describes the effect of introducing a cohort area into a vascular surgery ward where a sustained increase in new cases of meticillin-resistant Staphylococcus aureus (MRSA) made the implementation of standard MRSA infection control precautions untenable. A recent review of published reports concluded, 'that little evidence could be found to suggest that isolation measures recommended in the UK are effective'. The authors recommended a reporting format to enable the evidence for isolation to be gathered more systematically.

Review of 212 individuals attending a city centre genitourinary medicine clinic following acute sexual assault.

A retrospective case note review of 212 individuals (190 women) attending a city-centre Genitourinary Medicine clinic between 1/4/2002 and 31/3/2004 following an acute sexual assault. Direct referral by the Forensic Medical Examiner to the dedicated weekly clinic for victims of sexual assault facilitated the attendance of 55/113 attending the dedicated clinic. The 99 individuals who did not disclose a recent assault as the reason for attendance were seen at routine clinics.

The significance of voiding interval before testing urine samples for Chlamydia trachomatis in men.

Objective: To investigate the effect of time since last urination on chlamydial positivity rates in men.

Methods: Prospective study on men attending a genitourinary medicine clinic who were asked for the last time of their urination before obtaining their urine sample for testing for Chlamydia trachomatis with the Cobas Amplicor polymerase chain reaction (PCR) assay.

Results: Of the total of 1649 men studied, 621 (37.

Hepatitis B vaccination of men who have sex with men: experience with an accelerated course of vaccination in a genitourinary medicine clinic.

An accelerated course of hepatitis B vaccination was offered to men who had sex with men attending a genitourinary medicine clinic. The uptake and completion rates of the vaccine between 1 November 2002 and 28 February 2004 were compared with data for 1994. The uptake of vaccine was significantly higher during the former audit period than the latter (310 [98%] of 315 versus 146 [74%]).

Practice and problems with gastrostomies.

The development of gastrostomy placement has been an important technological advance in the enteral-access field. However, its rapid growth in popularity could be viewed as problematic. The endoscopist or intervention radiologist can no longer act as a technician but requires to follow-up this group of patients in order to determine outcomes that will inform future practice.

Pharmacological cardioversion for atrial fibrillation and flutter.

Background: Atrial fibrillation is the commonest cardiac dysrhythmia. It is associated with significant morbidity and mortality. There are two approaches to the management of atrial fibrillation: controlling the ventricular rate or converting to sinus rhythm in the expectation that this would abolish its adverse effects.

Audit of the management of victims of sexual assault in a city centre genitourinary medicine clinic.

A total of 113 individuals (101 women, 12 men) who had experienced sexual assault (SA) attended the genitourinary medicine clinic. Of the 60 patients who were seen at a dedicated clinic for victims of SA, the median age was lower, a greater number had reported to the police and the interval between assault and attendance was shorter, compared with the 53 who attended the routine walk-in service. However, the majority of the men attended routine clinics.