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    10930 results match your criteria Annals of the Royal College of Surgeons of England[Journal]

    1 OF 219

    Coccydynia - could age, trauma and body mass index be independent prognostic factors for outcomes of intervention?
    Ann R Coll Surg Engl 2018 Jan 15;100(1):12-15. Epub 2017 Sep 15.
    Royal Derby Hospital , Derby , UK.
    Introduction The aetiology of coccydynia can be multifactorial, with several associated factors such as obesity, female gender and low mood. The long-term results of operative interventions, such as manipulation under anaesthesia and coccygectomy are variable, ranging from 63-90%. Materials and methods Our aim was to identify whether age, trauma and body mass index (BMI) were independent prognostic factors in coccydynia treatment. Read More

    The surgical personality: does it exist?
    Ann R Coll Surg Engl 2018 Jan;100(1):72-77
    Department of Economics, Mathematics and Statistics, Birkbeck University of London , London , UK.
    Introduction This study aims to answer the question of whether surgeons have different personalities to non-surgeons. Methods Members of the Royal College of Surgeons of England were sent an email survey containing 50 standard questions from the Five Factor personality assessment, which scores each respondent in five key personality traits (conscientiousness, agreeableness, neuroticism, openness, extroversion). Results were analysed and compared with a population-level data set from a survey conducted by the BBC. Read More

    Modification, validation and implementation of a protocol for post-thyroidectomy hypocalcaemia.
    Ann R Coll Surg Engl 2017 Nov 28:1-5. Epub 2017 Nov 28.
    Sheffield Teaching Hospitals NHS Foundation Trust , UK.
    Introduction The management of post-thyroidectomy hypocalcaemia should facilitate early discharge, and reduce risks of hypocalcaemia, readmission and treatment related hypercalcaemia. This paper describes the implementation, evaluation and revision a protocol for the optimal management of this condition. Methods Day 1 parathyroid hormone (PTH) measurements in addition to calcium measurements were commenced following review of the unit's outcomes and literature on post-thyroidectomy hypocalcaemia. Read More

    Acute hand injury splinting - the good, the bad and the ugly.
    Ann R Coll Surg Engl 2017 Nov 28:1-5. Epub 2017 Nov 28.
    Department of Orthopaedic Hand Surgery, Morriston Hospital , Swansea , UK.
    Injuries to the hand comprise 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. The initial assessment and management of hand injuries is usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In the Department of Orthopaedic Hand Surgery, Morriston Hospital, we regularly observe patients presenting to the specialist hand fracture clinics having had initial management that shows no appreciation for the treatment objectives or the safe positions for splinting. Read More

    Surgical resection of a massive primary mediastinal liposarcoma with cervical extension.
    Ann R Coll Surg Engl 2017 Nov 28:e1-e3. Epub 2017 Nov 28.
    Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Papworth Everard , Cambridge , UK.
    A 73-year-old man was referred for surgical excision of a massive mediastinal and cervical liposarcoma following neoadjuvant chemotherapy. Surgery was performed via a cervical incision, sternotomy and right posterolateral thoracotomy. The tumour arose from the oesophagus, which underwent extensive dissection and was oversewn with pleura after tumour resection. Read More

    Colossal pilomatrixoma.
    Ann R Coll Surg Engl 2017 Nov 28:e1-e3. Epub 2017 Nov 28.
    Division of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, CA United States.
    We describe the largest reported case of pilomatrixoma in the literature. While pilomatrixomas typically present as small soft-tissue nodules of the head, neck and upper extremities, they can also present as much larger masses in atypical locations. When they present in their usual size, pilomatrixomas have typical imaging features and can be correctly diagnosed with imaging studies before histological confirmation. Read More

    The effect of non-steroidal anti-inflammatory drugs on severity of acute pancreatitis and pancreatic necrosis.
    Ann R Coll Surg Engl 2017 Nov 28:1-4. Epub 2017 Nov 28.
    University Hospital Southampton NHS Foundation Trust , UK.
    Introduction Acute pancreatitis (AP) is a common emergency presentation and can be disabling. There is significant morbidity and mortality associated with AP, and it places a considerable burden on the healthcare system. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to have a protective effect in some elective contexts. Read More

    Choledochal cyst of the proximal cystic duct: a taxonomical and therapeutic conundrum
    Ann R Coll Surg Engl 2017 11 28:e1-e4. Epub 2017 Nov 28.
    All India Institute of Medical Sciences , New Delhi , India.
    Isolated choledochal cysts involving the cystic duct are rare. We present a case of a choledochal cyst involving only the proximal cystic duct, and discuss the taxonomic and therapeutic challenges. There is a need for a clearly defined classification system for these cysts as they may be categorised as either type II or type VI cysts. Read More

    The effect of rectal washout on local recurrence following rectal cancer surgery.
    Ann R Coll Surg Engl 2017 Nov 28:1-6. Epub 2017 Nov 28.
    Norfolk and Norwich University Hospitals NHS Foundation Trust , UK.
    Introduction Local recurrence after surgery for rectal cancer is associated with significant morbidity and debilitating symptoms. Intraoperative rectal washout has been linked to a reduction in local recurrence but there is no conclusive evidence. The aim of this study was to evaluate whether performing rectal washout had any effect on the incidence of local recurrence in patients undergoing anterior resection for rectal cancer in the context of the current surgical management. Read More

    Urachal remnant causing umbilical in-drawing during micturition.
    Ann R Coll Surg Engl 2017 Nov 28:e1-e3. Epub 2017 Nov 28.
    Newcastle upon Tyne Hospitals NHS Foundation Trust UK.
    The urachus is a vestigial remnant of the allantois, which is normally obliterated during fetal life to become the median umbilical ligament, which runs between the urinary bladder and umbilicus in adults. Failure of obliteration leaves a tubular urachal remnant, which may present with disease. We report a unique case of a urachal remnant causing umbilical pain and in-drawing on micturition in a nine-year-old boy. Read More

    The significance of the pharyngeal veins during carotid endarterectomy: description of an anatomical triangle.
    Ann R Coll Surg Engl 2017 Nov 28:1-4. Epub 2017 Nov 28.
    Huddersfield Royal Infirmary , Lindley, Huddersfield , UK.
    Injuries to the hypoglossal and vagus nerves are the most commonly reported injuries during carotid endarterectomy. While unilateral single nerve injury is usually well tolerated, bilateral or combined nerve injuries can pose a serious threat to life. This study aims to increase awareness of the inferior pharyngeal vein, which usually passes posterior to the internal carotid artery but sometimes crosses anterior to it. Read More

    Chest wall resection and reconstruction for Rosai-Dorfman disease masquerading as a chest wall sarcoma.
    Ann R Coll Surg Engl 2017 Nov 28:e1-e3. Epub 2017 Nov 28.
    University Hospitals of Leicester NHS Trust , UK.
    Rosai-Dorfman disease (RDD) is a rare benign histiocytic proliferative disease that can present as a pseudotumour of soft tissue. We describe the first chest wall resection and reconstruction. Read More

    Hip fracture surgery in mixed-use emergency theatres: is the infection risk increased? A retrospective matched cohort study.
    Ann R Coll Surg Engl 2017 Nov 19;99(8):641-644. Epub 2017 Oct 19.
    Royal Surrey County Hospital , Guildford , UK.
    Introduction The National Institute of Health and Care Excellence recommends that people with hip fracture should have surgery on the day of, or the day after, admission. However, there remains unacceptable variation in performance around the country, with a range of 13-91% of patients meeting this target. Dedicated trauma lists have insufficient capacity in many hospitals. Read More

    Anorectal melanoma: experience from a tertiary cancer care centre in South India.
    Ann R Coll Surg Engl 2017 Oct 19:1-5. Epub 2017 Oct 19.
    Division of Surgical Oncology, Regional Cancer Centre , Trivandrum , Kerala.
    Introduction Mucosal malignant melanoma of the anorectum is a rare and aggressive disease, in which early diagnosis is difficult. The prognosis remains extremely poor, irrespective of the treatment. We share our experience in treating this malignancy at our centre in South India. Read More

    Analysis of intensive care admissions among paediatric obstructive sleep apnoea referrals.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):67-71. Epub 2017 Oct 19.
    Great Ormond Street Hospital for Children NHS Foundation Trust , UK.
    Introduction The aim of this study was to identify the proportion of children referred to a paediatric tertiary referral centre who required admission to the paediatric intensive care unit (PICU) following surgery for obstructive sleep apnoea (OSA) and to establish risk factors for these admissions. Methods Retrospective review of case notes and the operative database was performed for all children undergoing adenotonsillectomy for sleep disordered breathing and OSA symptoms in Great Ormond Street Hospital over a 10-year period. Results Overall, 1,328 children underwent adenotonsillectomy for sleep disordered breathing and OSA. Read More

    Neuroendocrine tumours within a Meckel's diverticulum.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):e10-e11. Epub 2017 Oct 19.
    Hospital Universitario de la Princesa , Madrid , Spain.
    A Meckel's diverticulum is a common anomaly of the gastrointestinal tract. Although the majority of patients do not have any symptoms, malignancies can develop inside these diverticula, with neuroendocrine tumours being the most common. Diverticulectomy is the best option for complicated diverticula but prophylactic resection of asymptomatic diverticula in adults remains controversial. Read More

    Infection of PTFE mesh 15 years following pedicled TRAM flap breast reconstruction: mechanism and aetiology.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):e18-e21. Epub 2017 Oct 19.
    Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK.
    The pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedure is still widely used for breast reconstruction. The repair of the flap harvest site in the transverse rectus abdominis muscle and sheath is often assisted by the use of prosthetic meshes. This decreases the risk of abdominal wall weakness and herniation but, being a foreign body, it also carries the risk of infection. Read More

    Surgical placement of rectus sheath catheters in a cadaveric cystectomy model.
    Ann R Coll Surg Engl 2017 Oct 19:1-5. Epub 2017 Oct 19.
    University of British Columbia , Vancouver UK.
    Introduction Surgically inserted rectus sheath catheters (RSCs) are used increasingly for analgesia after cystectomy and other abdominal surgery. Currently, there is little information on the optimal positioning of RSCs to allow maximal spread of local anaesthetic. This study sought to assess the spread of dye injected via RSCs and to highlight the extent of its coverage in a fresh unembalmed cadaveric cystectomy model in order to confirm the nerve endings that are likely to be anaesthetised with RSCs. Read More

    Ostomy creation with fewer sutures using tissue adhesives (cyanoacrylates) in inflammatory bowel disease: a pilot study.
    Ann R Coll Surg Engl 2017 Oct 19:1-4. Epub 2017 Oct 19.
    Division of Infection Control and Prevention, Hyogo College of Medicine , Hyogo , Japan.
    Introduction Fistula formation around the ostomy site is a stoma-related complication often requiring surgical intervention. This complication may be caused by sutures or may develop as a complication of inflammatory bowel disease. Before conducting a clinical trial, we set out to investigate the safety of ostomy creation with fewer sutures using tissue adhesives in this pilot study. Read More

    Video-assisted anal fistula treatment: a high volume unit initial experience.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):37-41. Epub 2017 Oct 19.
    Department of General Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital , Prescot , UK.
    Introduction Perianal fistulas are a common problem. Video-assisted anal fistula treatment is a new technique for the management of this difficult condition. We describe our initial experience with the technique to facilitate the treatment of established perianal fistulas. Read More

    Informed consent and the readability of the written consent form.
    Ann R Coll Surg Engl 2017 Nov 19;99(8):645-649. Epub 2017 Oct 19.
    Barts Health NHS Trust , UK.
    Introduction The aim of this study was to objectively ascertain the level of readability of standardised consent forms for orthopaedic procedures. Methods Standardised consent forms (both in summary and detailed formats) endorsed by the British Orthopaedic Association (BOA) were retrieved from and assessed for readability. Read More

    Crossing the bridge to VATS lobectomy.
    Ann R Coll Surg Engl 2017 Nov 19;99(8):650-652. Epub 2017 Oct 19.
    Leeds Teaching Hospitals NHS Trust , UK.
    Introduction The impact of the introduction of video assisted thoracoscopic surgery (VATS) on the management of lung cancer 20 years ago has been well documented. However, the uptake of VATS lobectomy in surgical practice worldwide has been slower than expected. We believe that this is partly due to a lack of consensus on how this procedure should be integrated into training programmes. Read More

    Is the number of new trauma and orthopaedic consultant posts increasing or decreasing?
    Ann R Coll Surg Engl 2017 Nov 19;99(8):591-593. Epub 2017 Oct 19.
    Stockport NHS Foundation Trust , UK.
    Introduction Trauma and orthopaedics is a popular surgical specialty in the UK. Recent changes to the National Health Service have suggested an imbalance with fewer jobs yet more trainees. Furthermore, subspecialisation is emerging within all surgical disciplines. Read More

    The hidden cost of deep neck space infectionsy.
    Ann R Coll Surg Engl 2017 Oct 19:1-6. Epub 2017 Oct 19.
    NHS Greater Glasgow and Clyde , UK.
    Introduction The incidence of deep neck space infection (DNSI) is rising and appears to be related to falling rates of tonsillectomy. The purpose of this study was to assess demographics of patients presenting with DNSI and the financial burden to the National Health Service (NHS). Methods Data were collected retrospectively on patients aged over 16 years admitted to NHS Greater Glasgow and Clyde with DNSI between 2012 and 2016. Read More

    Perineal colostomy prolapse: a novel application of mesh sacral pexy.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):e7-e9. Epub 2017 Oct 19.
    Louvain University Medical School , Brussels , Belgium.
    Full thickness colonic prolapse following pseudocontinent perineal colostomy has not been previously reported. Possible contributing factors include a large skin aperture at the site of the perineal stoma, the absence of anal sphincters and mesorectal attachments and the presence of a perineal hernia. A novel application of sacral pexy combined with perineal hernia repair using two prosthetic meshes is described. Read More

    The provision of surgical tracheostomies by maxillofacial surgeons in the UK: time for a dedicated tracheostomy team?
    Ann R Coll Surg Engl 2017 Oct 19:1-4. Epub 2017 Oct 19.
    Department of Oral and Maxillofacial Surgery, University Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust , Coventry UK.
    Surgical tracheostomy is a commonly provided service by surgical teams for patients in intensive care where percutaneous dilatational tracheostomy is contraindicated. A number of factors may interfere with its provision on shared emergency operating lists, potentially prolonging the stay in intensive care. We undertook a two-part project to examine the factors that might delay provision of surgical tracheostomy in the intensive care unit. Read More

    Transoral laser surgery for laryngeal carcinoma: has Steiner achieved a genuine paradigm shift in oncological surgery?
    Ann R Coll Surg Engl 2018 Jan 19;100(1):2-5. Epub 2017 Oct 19.
    Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Faculty of medicine, Dalhousie University , Halifax, Nova Scotia , Canada.
    Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predominantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase 'paradigm shift' in his groundbreaking book The Structure of Scientific Revolutions. Read More

    Penetrating neck injuries: a guide to evaluation and management.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):6-11. Epub 2017 Oct 19.
    ENT Head and Neck Surgery, Flinders Medical Centre and Flinders University , South Australia , Australia.
    Introduction Penetrating neck injury is a relatively uncommon trauma presentation with the potential for significant morbidity and possible mortality. There are no international consensus guidelines on penetrating neck injury management and published reviews tend to focus on traditional zonal approaches. Recent improvements in imaging modalities have altered the way in which penetrating neck injuries are now best approached with a more conservative stance. Read More

    Variable life adjusted display methodology for continuous performance monitoring of carotid endarterectomy.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):63-66. Epub 2017 Oct 19.
    Academic Vascular Unit, Hull Royal Infirmary , Hull UK.
    Introduction The aim of this study was to use variable life-adjusted display (VLAD) methodology to monitor performance of six vascular surgeons undertaking carotid endarterectomy in a single institution. Materials and methods This was a prospective study with continuous analysis. A risk score model to predict 30-day stroke or death for individual patients was developed from data collected from 839 patients from 1992 to 1999. Read More

    Hydronephrotic kidney with multiple extra-renal calyces.
    Ann R Coll Surg Engl 2017 Nov 19;99(8):e219-e220. Epub 2017 Oct 19.
    Urology, Great Ormond Street Hospital , London UK.
    Extra-renal calyces are a rare anomaly of the renal collecting system, characterised by the presence of calyces and pelvis outside the renal parenchyma. It may also be associated with other anomalies, such as renal ectopia, fusion and malrotation. We describe an unusual case of extra-renal calyces with six long calyces arising from a suspected multicystic dysplastic kidney that was successfully managed laparoscopically. Read More

    Splenic artery pseudoaneurysm causing delayed gastrointestinal bleeding after gastrocolonic fistula following sleeve gastrectomy.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):e15-e17. Epub 2017 Oct 19.
    Hospital Universitario de la Princesa , Madrid , Spain.
    Delayed gastrointestinal bleeding in the context of a gastric fistula is a very rare complication of longitudinal sleeve gastrectomy. We report the case of a patient who presented with massive gastrointestinal bleeding from a pseudoaneurysm arising from the splenic artery following complications after a longitudinal sleeve gastrectomy several months previously. The case was successfully managed with angiographic embolisation and we present our experience with recommendations for managing this rare but life-threatening complication. Read More

    The use of viable cryopreserved placental tissue in the management of a chronic rectovaginal fistula.
    Ann R Coll Surg Engl 2017 Nov 19;99(8):e236-e240. Epub 2017 Oct 19.
    Department of General Surgery, Johns Hopkins Hospital , Baltimore, MD, USA.
    We present a case of a chronic recurrent rectovaginal fistula that initially arose from complications of haemorrhoid surgery and had failed multiple prior surgical repairs. The fistula was successfully managed using viable cryopreserved placental tissue. Read More

    Iliac crest apophyseal insufficiency avulsion fractures.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):e4-e6. Epub 2017 Oct 19.
    Department of Trauma and Orthopaedics, Leighton Hospital , Crewe.
    Iliac crest apophyseal avulsion fractures are rare injuries caused mainly through forceful contraction of attached muscles during high level sporting activities. We present the first case of a spontaneous iliac crest apophyseal avulsion insufficiency fracture in a patient with severe atopic eczema on oral steroids and review the relevant literature. Read More

    Cost-effectiveness of routine imaging of suspected appendicitis.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):47-51. Epub 2017 Oct 19.
    Department of General Surgery, Queen Alexandra Hospital , Portsmouth , UK.
    Introduction The misdiagnosis of appendicitis and consequent removal of a normal appendix occurs in one in five patients in the UK. On the contrary, in healthcare systems with routine cross-sectional imaging of suspected appendicitis, the negative appendicectomy rate is around 5%. If we could reduce the rate in the UK to similar numbers, would this be cost effective? This study aimed to calculate the financial impact of negative appendicectomy at the Queen Alexandra Hospital and to explore whether a policy of routine imaging of such patients could reduce hospital costs. Read More

    The lesser spotted pregnant surgeon.
    Ann R Coll Surg Engl 2017 Oct 19:1-4. Epub 2017 Oct 19.
    King's College Hospital , London , UK.
    With more women entering surgical training, it will become more commonplace to encounter pregnant surgeons. This paper discusses the evidence for work-related risk factors as well as outlining the rights of a pregnant doctor. There are, in fact, very few real risks to pregnancy encountered as a surgeon, with the main risks involving standing or sitting for long periods and fatigue, which can be managed with support from the department. Read More

    Portal hypertension and chylous ascites complicating acute pancreatitis: the therapeutic value of portal vein stenting.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):e1-e3. Epub 2017 Oct 19.
    Department of Hepatobiliary and Pancreatic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust , London.
    Chylous ascites as a consequence of acute pancreatitis is very rare. We present an unusual case of a 73-year-old man who developed refractory chylous ascites one month after an acute severe episode of gallstone pancreatitis, associated with portal hypertension. He was successfully treated with portal vein stenting, which has remained patent to date. Read More

    Large cystic lympangioma of the pancreas: a case reportum.
    Ann R Coll Surg Engl 2018 Jan 19;100(1):e12-e14. Epub 2017 Oct 19.
    Department of Surgical Gastroenterology, Sakra World Hospital, Bengaluru , Karnataka , India.
    Lymphangioma of the pancreas is rare and presents as a large cystic mass in the retroperitoneum. The pancreatic origin can be confirmed by careful evaluation of cross sectional imaging. Preoperative differentiation from other pancreatic cystic neoplasms is difficult but possible. Read More

    A late presentation of Loeys-Dietz syndrome associated with an aortic root aneurysm.
    Ann R Coll Surg Engl 2017 Feb 13:e1-e2. Epub 2017 Feb 13.
    Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust , UK.
    Loeys-Dietz syndrome (LDS) is characterised by a mutation in the transforming growth factor beta receptor, and is strongly associated with aortic aneurysms and rupture. Most cases of LDS present in the second decade of life, with the average life expectancy being 37 years. We report a case of suspected LDS (owing to significant family history of the disorder) that presented in the seventh decade of life. Read More

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