Journal of the Royal College of Surgeons of Edinburgh
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A nurse-led Pre-operative Assessment Clinic was introduced into the General Surgical Directorate at the Royal Hallamshire Hospital in August 1993 to provide a general medical and anaesthetic pre-operative assessment, to give information, both written and verbal, to patients about their operations and to identify social problems which might delay discharge. Patients were seen either at the time of their original clinic appointment or subsequently on a recall basis, prior to admission to hospital. The clinic was run by two out-patient nurses working to agreed protocols. ⋯ Eighteen per cent of investigations were repeated unnecessarily because the reports were unavailable or considered out of date. However, only 1% of patients pre-operatively assessed had their operations cancelled after their admission, compared with 6% of non pre-operatively assessed patients. Given the total number of patients admitted for surgical procedures per year, the introduction of comprehensive pre-operative assessment for all patients could result in a substantial reduction in cancellations following admission.
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J R Coll Surg Edinb · Jun 1997
Recurrent laryngeal nerve dysfunction following carotid endarterectomy.
Recurrent laryngeal nerve dysfunction is a significant complication of carotid endarterectomy and vocal cord paralysis is a major source of morbidity. This study prospectively assessed patients undergoing carotid endarterectomy to determine the nature and frequency of vocal cord damage and attempt to identify avoidable factors. Fifty consecutive patients undergoing carotid endarterectomy for symptomatic disease were studied. ⋯ The incidence of vocal cord paralysis in this group was less than many of the reported series. This could be due to the technique of minimal dissection which may prevent disturbance of the vagal segmental blood supply. Pre-operative vocal cord assessment is essential in all patients undergoing carotid endarterectomy.
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J R Coll Surg Edinb · Feb 1997
Comparative StudyUltrasonography in the diagnosis of acute appendicitis.
The purpose of this study was to assess our results of using graded compression ultrasonography (US) to confirm the diagnosis of acute appendicitis. Graded compression US was performed on 94 patients who presented at the Lehigh Valley Hospital, Allentown, Pennsylvania with an equivocal clinical picture of acute appendicitis. ⋯ We conclude that graded compression US was useful to rule out the diagnosis of acute appendicitis and helped to avoid unnecessary appendectomies and reduced negative laparotomies. Our results proved to be comparable to previously reported studies.
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Angola is one of the most heavily mined countries in the world. Despite the vast effort made to clear landmines, very few accurate figures for casualty rates are available. The town of Kuito in central Angola is surrounded by minefields left after the 22-month siege by the rebel UNITA forces. ⋯ Mortality from anti-personnel mines was 1.7% (1/60). Seventy per cent of all lower limb amputations in Kuito are performed as a result of landmine injury (53/76). Landmines exert a severe strain on already stretched surgical services, and a significant burden of morbidity on the population of Kuito.