Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · May 2010
Is peri-articular multimodal drug infiltration in knee arthroplasty safe when used in conjunction with autologous retransfusion drains?
Adequate peri-operative analgesia following total knee arthroplasty (TKA) promotes earlier rehabilitation but remains problematic because of the drug side-effects. Peri-articular multimodal drug infiltration (PMDI) has been developed as an alternative strategy to avoid such complications. Autologous retransfusion drains reduce the need for peri-operative allogenic blood transfusions and the consequent risk. There is a theoretical risk of local anaesthesia toxicity when these systems are used concurrently. We performed a review of current practice to quantify this risk. ⋯ The theoretical risk of local anaesthesia toxicity when these systems are used together is negligible and we conclude that peri-articular multimodal drug infiltration is safe in conjunction with the use of autotransfusion drains.
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Ann R Coll Surg Engl · Apr 2010
Multicenter StudyEvaluation of the introduction of a standardised protocol for the staging and follow-up of colorectal cancer on resection rates for liver metastases.
In 2004, an audit in our unit demonstrated wide variation in liver resection rates for colorectal cancer (CRC) metastases within the cancer network. Subsequently, a network-wide CT-based follow-up and referral policy was introduced for all patients. A second audit was performed to assess the impact of the guidelines on liver resection rates. ⋯ Introduction of a referral protocol standardised resection rates from the four district hospitals, but these remain lower compared to the specialist centre. The wide-spread adoption of a policy to discuss all patients with liver metastases at an advanced disease multidisciplinary team meeting, in the presence of hepatobiliary specialists, may further increase resection rates across the UK.
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Ann R Coll Surg Engl · Apr 2010
Case ReportsImplantation of an intercostal nerve stimulator for chronic abdominal pain.
Chronic abdominal pain is not uncommon and can be difficult to manage. We present the case of a 17-year-old man with a 4-year history of chronic abdominal pain. ⋯ We report the successful implantation of a right D11 intercostal nerve stimulator to control the patient's pain. This is the first report of an implantable intercostal nerve stimulator to control intractable chronic abdominal pain.
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Ann R Coll Surg Engl · Mar 2010
Case ReportsManubriosternal subluxation/dislocation can lead to manubriosternal septic arthritis in patients with kyphoscoliosis.
Locally deranged joint anatomy can predispose to septic arthritis which can be managed by surgical debridement. We present a case of manubriosternal subluxation/dislocation caused by kyphoscoliosis leading to manubriosternal septic arthritis.