Surg J R Coll Surg E
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Surg J R Coll Surg E · Aug 2017
ReviewManagement of pulmonary nodules in head and neck cancer patients - Our experience and interpretation of the British Thoracic Society Guidelines.
and purpose of the study: The frequency of lung nodules in the head and neck cancer population is unknown, currently the only guidance available recommends following local policy. The aim of this study was to determine the incidence of pulmonary nodules in our head and neck cancer group and interpret the recently updated British Thoracic Society (BTS) Lung Nodule Guidelines in a head and neck cancer setting. ⋯ The MDT in NHS Lothian has reviewed the BTS guidance and now has a local policy for the management of lung nodules in head and neck cancer patients. Lung Nodules in the head and neck cancer population are common >10%. Higher risk patients with larger nodules should be risk assessed with validated assessment tools. PET-CT has a place in the assessment of lung nodules when risk of malignancy is high.
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Surg J R Coll Surg E · Aug 2017
The impact of helipad designation on meeting the best practice tariff for fractured neck of femur cases in a major trauma centre.
Hip fractures represent a significant burden to the NHS: the cost for all UK hip fractures is approximately £2 billion and in 2013, 64 838 people were admitted to hospital with a fractured neck of femur (FNOF). In April 2010 St George's NHS Hospital was designated one of four Major Trauma Centres (MTC) in London. Following MTC designation, in April 2014 St George's Hospital opened a helipad. ⋯ Two samples were analysed: 'pre-helipad' (from October 2013 to March 2014) during which 125 patients presented with FNOF, and 'post-helipad' (from April 2014 to September 2014) during which 122 patients presented with FNOF. The percentage of cases receiving surgery within 36 h, receiving joint care of a consultant geriatrician and a consultant orthopaedic surgeon, and receiving assessment by a geriatrician in the perioperative period were found not to have been negatively impacted by the helipad. However, completion of routine recommended assessments including admission using the agreed assessment protocol (96.6% vs. 50%, p < 0.05) and completion of two Abbreviated Mental Test (AMT) scores (74.7% vs. 58%, p = 0.007) were found to have been compromised.
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Surg J R Coll Surg E · Jun 2017
ReviewRole of transoral robotic surgery in current head & neck practice.
Morbidity and mortality associated with increasingly radical doses of chemoradiotherapy have led many to question the current standard of care in head and neck cancer. Recently, surgeons have developed minimally invasive, transoral techniques which have demonstrated excellent survival and favourable functional outcomes. Transoral robotic surgery (TORS) is the most recent, cutting edge in the evolution of transoral techniques; TORS allows surgeons unprecedented access to and visualisation of the upper aerodigestive tract. ⋯ Surgical care for upper aerodigestive tract cancers has changed dramatically over the last three decades with technological advances in tumour imaging and resection. Recent advances in mechanical instrumentation and energy devices allow surgeons to remove head and neck cancers transorally; it is only rarely that the extrinsic muscles of the neck and the tongue are involved and the transoral route leads to reduced disruption of the external musculature, quicker recovery and a better functional outcome. In this review we will focus exclusively on the advances in transoral robotic surgery which have transformed the shape of resective head and neck cancer surgery.
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Surg J R Coll Surg E · Feb 2017
Refinement of myotome values in the upper limb: Evidence from brachial plexus injuries.
We reviewed patients with partial supraclavicular brachial plexus injuries in order to refine the myotome values of the upper limb. ⋯ In upper plexus injuries paralysis of FCR indicated involvement of C7 root in addition to C5 and C6 roots. The results provide new detail of innervation of muscles acting on the hand. Flexor muscles and intrinsic muscles of the thumb and radial fingers (median nerve) have an important contribution from T1, while for those acting on the ulnar digits (ulnar nerve) the main contribution is from C8 with some input from C7. T1 also gives consistent innervation to extensor pollicis longus. A revised myotome chart for the upper limb is proposed.
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Surg J R Coll Surg E · Feb 2017
Review Meta Analysis Comparative StudyLocal anaesthesia versus spinal anaesthesia in inguinal hernia repair: A systematic review and meta-analysis.
Inguinal hernias are a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of local anaesthesia when compared to spinal anaesthesia in individuals undergoing open inguinal hernia repair. ⋯ Our findings support the use of local anaesthetic in adult patients undergoing open repair for a primary inguinal hernia.