Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · May 1996
Emergency thoracotomy for thoracic trauma in the accident and emergency department: indications and outcome.
To assess the efficacy of emergency thoracotomy performed for thoracic trauma in the accident and emergency department, a retrospective analysis of patients who underwent this procedure and were brought to hospital by the Helicopter Emergency Medical Service was carried out. Between 1991 and 1994, 16 patients had emergency thoracotomy performed in the accident department. Twelve patients had sustained blunt trauma and four patients had sustained penetrating injuries. ⋯ Our results demonstrate experience of one of the first phase Level One trauma centres in the United Kingdom. From our small series, we believe that selection criteria for emergency thoracotomy in trauma patients need to be revised. From this series and a review of the literature, patients with penetrating injuries, vital signs at the scene and those with a high index of suspicion for tamponade seem to benefit most from thoracotomy in the emergency setting.
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An accurate audit of consultant manpower in paediatric surgery in the UK was performed based on two surveys carried out in 1992 and 1994. There were 70 paediatric surgeons in 1992 and 84.5 in 1994 (a 21 per cent increase). ⋯ The expressed aim of the British Association of Paediatric Surgeons is to achieve a ratio of 1 per 500,000 population which implies a further increase to about 110 consultant posts in the UK. It will be necessary to plan for a commensurate increase in the number of training posts in this specialty.
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There is concern that the shortened period of training to be introduced for the new Specialist Registrar Grade is incompatible with the limitation of hours of work required by the New Deal. Surgeons in training may require more experience than other specialties but the Calman proposals introduce the concept of a structured curricular training which will mean a radical change in the way that surgical training is delivered. The changes will be uncomfortable and may need to be modified in the light of experience but the end-result will be worthwhile and should be achievable within the new time constraints.
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Ann R Coll Surg Engl · Mar 1996
Letter Case ReportsAcute scybalous colonic obstruction and perforation.
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Ann R Coll Surg Engl · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialSubjective effects of double gloves on surgical performance.
This randomised trial compared single gloves with combinations of double gloves to determine the subjective effects on comfort, sensitivity and dexterity in 32 surgeons. Glove perforation rates were also compared. Single gloves of the surgeon's normal size (method A) were used as control. ⋯ When the three types of double gloving were compared, there appeared to be advantages for method C for all modalities, but the differences did not reach statistical significance; also, more surgeons expressed a preference for method C. Perforation of the inner gloves was significantly less for double gloves than for single gloves. We conclude that double gloves often protect the surgeon against needle perforations, but are felt to impair comfort, sensitivity and dexterity.