Surg J R Coll Surg E
-
Immediate and early trauma death rates are determined by "first hits" such as hypoxia, hypotension and organ injury, while late mortality correlates closely with "second hits" such as infection. An imbalance between the early systemic inflammatory response (SIRS), and the later compensatory counter-inflammatory response (CARS), is considered to be responsible for much post-traumatic morbidity and mortality. ⋯ This review describes the impact of injury on the innate and adaptive immune systems. Though it is worth noting that the features of the immune response to injury overlap in many areas with immune dysregulation in sepsis, we attempt here to elucidate the mechanism by which injury predisposes to infection rather than to describe the alterations in host immunity consequent to established sepsis.
-
Several options exist with regard to flexible pharyngo-laryngoscope sterilisation. We audited the use of disposable sheaths in our department over a six-month period. ⋯ We have found chlorine dioxide wipes to be a satisfactory alternative means of nasendoscope disinfection. Possible time constraints aside, there are no advantages of sheath use over our current method. Chlorine dioxide wipes are also preferable from a financial point of view.
-
Surg J R Coll Surg E · Feb 2006
Comparative StudyOutcome of treatment of primary and recurrent pilonidal sinuses with the Limberg flap.
Surgical treatment of pilonidal sinus disease has a significant morbidity and recurrence rate. The rhomboid flap of Limberg is a transposition flap that has been advocated for treatment of this condition. We present our experience with the Limberg technique for both primary and recurrent pilonidal sinuses. ⋯ Despite the risk of wound complications, this method is particularly useful for complex sinuses with extended tracts where radical excision leaves a large defect. It is also suitable for cases where simpler operations have failed and carries a low risk for recurrence.
-
Surg J R Coll Surg E · Feb 2006
Women presenting with lower abdominal pain: a missed opportunity for chlamydia screening?
Many young women presenting with lower abdominal pain are referred to general surgeons with possible appendicitis. For some of these patients there will be a gynaecological cause for their pain. There has been a steady increase in the incidence of Chlamydia infections and pelvic inflammatory disease (PID) among the general population. Therefore, are general surgeons considering this as a diagnosis for lower abdominal pain in women? ⋯ Current guidelines for Chlamydia trachomatis screening produced by the Chief Medical Officer (CMO) include screening in women presenting with lower abdominal pain as well as those with post-coital or intermenstrual bleeding. Most women who present with classical symptoms of PID will present to gynaecological specialities for further management. However, a significant number of women presenting atypically will be referred to surgeons to exclude gastrointestinal causes for their lower abdominal pain. These women could and probably should be screened for Chlamydia trachomatis.