Journal of the Royal College of Surgeons of Edinburgh最新文献

The place of a D2 gastrectomy for dealing with an antral stomach cancer inpatients in the West is a matter of continuing debate. This article describes a standardised operative procedure with the aim of achieving a satisfactory clearance of the gastric cancer in the antrum and a systematic removal of the regional draining lymphatics.

Pressure changes around the femoral nerve were monitored throughout 10 consecutive primary total hip replacements to identify any surgical steps that might raise pressure around the nerve and be implicated in iatropathic palsy. The only notable variable was the patient himself/herself. The only step that consistently raised pressure around the nerve, sometimes to alarming levels, was use of a retractor sited on the anterior lip of the acetabulum. Pressure changes were modest in patients with an endomorphic body type suggesting relative protection from this injury by a thicker soft cushion.

Fixation of small articular fragments in intra-articular fractures may be difficult and best results are achieved with restoration of anatomical position. A simple technique is described for ensuring good reduction and stabilisation of such articular fragments.

Spontaneous rupture of the inferior vena cava is a rare clinical entity. Diagnosis of this condition, in the absence of any relevant history, is usually made at laparotomy. Only one such case has previously been reported in the literature. We report a case of spontaneous rupture of the inferior vena cava which was diagnosed following laparotomy for hypovolaemia and acute abdominal pain. This case highlights the fact that spontaneous rupture of the inferior vena cava may be a cause of massive intra-abdominal bleeding not associated with trauma or rupture of the abdominal aorta.

A series of 53 closed tibial fractures were treated with interlocking intramedullary nailing. Excluding the routine postoperative radiographs at the time of surgery, a median number of seven radiographs were taken per patient (range 2-13). In total, 343 radiographs were taken after the postoperative film. Of these 343 radiographs, only nine (3%) radiographs led to a decision for clinical intervention. No radiograph in the first 10 weeks after surgery changed management. A reduction in the use of post-operative radiography after tibial nailing is recommended.

Apoptosis is the biological process by which cells in tissues undergo programmed death. This process is morphologically identifiable and characterised by light and electron microscopy. However, the biological mechanisms underlying this process, as yet, are poorly understood and in need of elucidation. As apoptotic tumour cells can be identified and counted by light microscopy, there has been interest in the application of the enumeration of apoptosis in malignant growths as a putative prognostic marker. This review outlines the rationale for and discusses the relevance of using such an approach in clinical practice.

Open tracheostomy is performed less frequently thereby increasing the likelihood of morbidity, e.g. bleeding. The simple modification described aids the technical process and minimises problems with the procedure.

The purpose of this article is to discuss the prevalence and intensity of bacteraemia associated with orthodontic procedures and help formulate practical guidelines for orthodontists treating children with congenital or acquired heart disease. Preliminary results demonstrate a significant increase in the intensity of bacteraemia from baseline following insertion of an orthodontic separator. The potential for development of bacterial endocarditis (BE) is extremely low, questioning the need for antibiotic prophylaxis for procedures other than extractions. However, for patients who are 'at risk' a very high standard of oral hygiene is essential and much of the responsibility lies with the individual patients to learn to protect themselves.