Annales chirurgiae et gynaecologiae
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The following guidelines are recommended in the management of malignant melanoma. An excisional biopsy is the appropriate diagnostic procedure for a skin lesion suspected of being a melanoma. The advised margin for diagnostic excision is 2 mm of macroscopically normal skin around the lesion; the margins for therapeutic excision are 1 cm of normal skin for a lesion with a Breslow thickness of < 2 mm and 2 cm when the Breslow thickness is > 2 and < or = 4 mm. ⋯ Regular routine blood tests and radiological examinations are not considered to be worthwhile. There is no evidence that the growth of micro-metastases is stimulated by hormonal changes during pregnancy or contraceptive pill use. Excessive exposure to ultraviolet radiation should be discouraged.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cannulated screws versus hemiarthroplasty for displaced intracapsular femoral neck fractures in demented patients.
There are no randomised trials comparing internal fixation and hemiarthroplasty for a displaced intracapsular femoral neck fracture in relation to mental state. ⋯ Postoperative mortality is high and the chance of successful rehabilitation very small for both types of treatment in this group of patients. In our opinion, demented patients should not be treated with a major surgical procedure like hemiarthroplasty. Internal fixation should be considered the treatment of choice, because it is a smaller operation than prosthetic replacement, with less morbidity. If adequate reduction can not be achieved, a primary hemiarthroplasty should be performed.
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Case Reports
Treatment of infection and non-union after bilateral complicated proximal tibial fracture.
Complicated tibial fractures form a great challenge for orthopaedic surgeons. Non-unions and infections are more common in complicated than in closed fractures. In the present study, we describe a patient case treated for non-union combined to chronic osteomyelitis after bilateral open proximal tibial fractures. ⋯ The use of commercial mixed xeno-/autogenous-bone graft may provide a feasible alternative in complicated chronic non-unions of the tibia even when an infection is present, especially when autogenous bone is not easily available after previous attempts of bone grafting.