Postcholecystectomy syndrome (PCS).

The term postcholecystectomy syndrome (PCS) comprises a heterogeneous group of symptoms and findings in patients who have previously undergone cholecystectomy. Although rare, these patients may present with abdominal pain, jaundice or dyspeptic symptoms. Many of these complaints can be attributed to complications including bile duct injury, biliary leak, biliary fistula and retained bile duct stones.

"Mouth to mouth ventilation": a comparison of the laryngeal mask airway with the Laerdal Pocket Facemask.

Ten nurses with basic airway management experience were formally trained to use a classic laryngeal mask airway (LMA) and a Laerdal Pocket Facemask (LPFM) for oxygen enriched expired air ventilation (EEAV). They then used both of these devices for EEAV in a randomised fashion in 100 anaesthetised ASA I/II patients for elective surgery. EEAV was considered successful if the patient's arterial oxygen saturation was maintained above 93% on room air for 3 min.

Immunoprophylaxis in asplenic patients.

The asplenic patient is at risk of overwhelming post-splenectomy infection (OPSI) due to encapsulated bacteria, namely pneumococcus, haemophilus influenza B and meningococcal C pathogens. The lifetime risk is 1-2% with the estimated mortality being in the region of 40-70% (Davidson RN, Wall RA. Prevention and management of infections in patients without a spleen.

Is the retrojugular approach safer than the conventional approach for carotid endarterectomy?

Background: The retrojugular approach is promoted as an alternative to traditional antejugular carotid endarterectomy. Absence of named posterior venous branches and ease of distal internal carotid dissection reduce time for carotid exposure together with improved distal exposure. However, a higher incidence of local nerve injury and persistent hoarse voice has been reported.

Durability of botulinum toxin treatment for axillary hyperhidrosis.

Objectives: Botulinum toxin injection effectively treats axillary hyperhidrosis. Durability estimates of 3-14 months, based on self re-referral may overestimate duration. Our objective was to determine treatment durability by active follow-up of patients.

Damage control surgery.

The principles of trauma surgery have evolved during the past 20 years; from initial aggressive, definitive management of all surgical injuries in the traumatised patient to an abbreviated laparotomy, secondary correction of abnormal physiological parameters and then planned definitive re-exploration; the damage control sequence.

Managing capacity issues in clinical placements for pre-registration nurses.

Aims And Objectives: To explore influences on decision-making concerning placement capacity planning for supporting nursing students in clinical placements. The research questions were: * How are decisions relating to capacity planning and management of the learning environment made within the practice areas? * What factors were or are perceived as important to take into consideration when making these decisions?

Background: It is already known that clinical placements are pivotal to pre-registration nurse education. The recent large expansion of nurse education places means that more students require clinical placements than previously.

Late onset of abducens palsy after Le Fort I maxillary osteotomy.

Abducens nerve palsy after low-level Le Fort 1 maxillary osteotomy is a rare complication, but with few cases reported, its true incidence is not known. We report an unusual case of late postoperative onset of abducens palsy that differs from existing case reports.

A comparison of sub-Tenon's with peribulbar anaesthesia in patients undergoing sequential bilateral cataract surgery.

The aim of this study was to compare efficacy and particularly patient preference of sub-Tenon's anaesthesia with peribulbar anaesthesia in patients undergoing sequential, bilateral, cataract surgery. Fifty patients were randomised to either sub-Tenon's or peribulbar anaesthesia for their first operation and the alternative technique for their subsequent operation. Intra-ocular pressure was measured, globe and lid akinesia were scored, patients completed a visual rating score of injection and operative pain and their preference for anaesthesia was assessed.

Botulinum toxin for pelvic pain in women.

Pelvic pain is a common disorder in women, causing significant morbidity. Often the etiology is not clear as it results from a complex interaction between neurologic, musculoskeletal and endocrine systems that is further influenced by behavioral and psychological factors. A comprehensive approach to the problem requires recognition of the multiple organ systems that may be involved.

Patterns of treatment of osteoradionecrosis with hyperbaric oxygen therapy in the United Kingdom.

We aimed to find out the number of patients with osteoradionecrosis (ORN) being treated by hyperbaric chambers in the UK during 2006-07, and the protocols that were being used. We did a telephone survey of 76 chambers to find out whether they treated patients with ORN, how many patients they treated in 2006-07, what chamber pressure they used, the duration of each session, and the total number of sessions/patient. A total of 25 chambers treated 273 patients with ORN in 2006-07; 10 were listed by the British Hyperbaric Association (BHA) and 15 were at multiple sclerosis (MS) centres.

Chronic type B dissecting aortoiliac aneurysm repair complicated by congenital pelvic kidney.

Although the association between abdominal aortic aneurysm and pelvic kidney is rare, previous reports have described various methods of repair with successful preservation of pelvic kidney function. We describe a unique case complicated by aortic dissection. Successful intra-operative perfusion of the kidney was maintained via a temporary axillorenal shunt.

Exeter-Ogee total hip replacement using the Hardinge approach; the ten to twelve year results.

We reviewed 131 consecutive primary total hip replacements implanted into 127 patients between 1995 and 1997. Surgery was performed through a Hardinge approach using the Exeter universal stem in combination with the Ogee Elite acetabular component.Five of 131 hips have required revision.

Presumed interaction of fusidic acid with simvastatin.

A 63-year-old man was admitted 6 weeks after an elective abdominal aortic aneurysm repair following which methicillin resistant Staphylococcus aureus (MRSA) had been cultured from the aneurysmal sac. He had been commenced on a course of fusidic acid at discharge in addition to his ongoing statin prescription and presented 4 weeks later with symptoms consistent with rhabdomyolysis. Severe rhabdomyolysis was confirmed and despite prolonged and complicated critical care management, his treatment was unsuccessful.

Outcome measures after TVT for mixed urinary incontinence.

This study assessed the outcome of tension-free vaginal tape (TVT) in the treatment of mixed incontinence using the Medical Epidemiologic and Social Aspects of Ageing (MESA) questionnaire and other outcome measures used by the British Society of Urogynaecology (BSUG) database. Forty women undergoing TVT completed a MESA questionnaire pre-operatively and at 6 months post-operatively. Information was also obtained about three outcome measures of the BSUG database-patients' global impression of outcome and stress and urge symptom analyses.

Should all patients undergo postoperative duplex imaging to detect a deep vein thrombosis after varicose vein surgery?

Objectives: Deep vein thrombosis (DVT) is a serious complication of varicose vein surgery, with attendant risks of pulmonary embolization. Prospective duplex screening identifies DVT in 5% of patients compared to clinical incidence of approximately 1%. Universal duplex screening is costly, and the benefits of diagnosing subclinical DVT are unproven.

Long-term follow-up of patients with lichen sclerosus: does it really happen?

Lichen sclerosus is a common condition affecting the vulva and long-term follow-up is recommended. We audited a group of patients discharged from the vulval clinic and found that 38% had not seen their GP 12 months after discharge. Of those that were seen, 17% were not examined.

Morphea of the breast: case reports and review of literature.

Morphea of the breast is an uncommon skin condition associated with autoimmune disorders and has also been described following radiotherapy. The inflammatory stage of morphea can commonly be mistaken for a breast abscess or inflammation. We report two cases of localized scleroderma affecting the breast with no history of autoimmune disease or radiation treatment.