The Avocado Hand – the UK Experience of the Management of Avocado Hand Injuries

2020 ◽  
Vol 25 (04) ◽  
pp. 402-406
Author(s):  
Soha Sajid ◽  
James Gill ◽  
Adrian Chojnowski ◽  
Rohit Singh
Keyword(s):  
Surgical Management ◽  
Young Patients ◽  
Hand Injuries ◽  
Dominant Hand ◽  
Patient Demographics ◽  
Outpatient Visits ◽  
The Uk ◽  
Nutritional Benefits ◽  
Serious Injuries

Background: Avocados are increasingly being consumed due to the nutritional benefits they provide. Avocado related hand injuries reflect their increasing popularity. Most injuries occur in attempting to de-stone the fruit. This is a prospective cohort study reviewing hand injuries sustained from preparing the fruit. Methods: Data was prospectively collected from three centres across United Kingdom (UK) over a 4-year period. The data was analysed for patient demographics, nature and zone of injury and management required. Results: A total of 35 patients and 42 injuries were included in the study. The median age of patients presenting with these injuries was 33 years, with majority of injuries occurring in the 21–30 age group. Most (88%, n = 31) of patients were male. Majority (85%, n = 36) of injuries happened during the de-stoning of the fruit. All injuries occurred in the non-dominant hand, with 70%, (n = 30) of wounds being sustained in zone 3. All injuries required surgical management and needed between 1 to 6 follow up outpatient visits. Vital structures such as tendons, digital nerves, pulleys and joint capsule were frequently implicated and required exploration or repair. Conclusions: Avocado related hand wounds are serious injuries with an associated morbidity. They frequently sustained by young patients. They usually require surgical management and may need numerous outpatient attendances. Caution and public education should be advocated on the preparation of avocados. This is the largest study to date that has reviewed the surgical management of avocado hand injuries.

scholarly journals Surgical management of Bertolotti’s syndrome in two adolescents and literature review

2019 ◽  
Vol 10 ◽  
pp. 135
Author(s):  
Christopher E. Louie ◽  
Jennifer Hong ◽  
David F. Bauer
Keyword(s):  
Back Pain ◽  
Surgical Management ◽  
Young Patients ◽  
Transverse Process ◽  
Surgical Removal ◽  
Long Term Outcomes ◽  
Lumbosacral Transitional Vertebra ◽  
Radicular Symptoms

Background: Bertolotti’s syndrome is defined by back pain and/or radicular symptoms attributed to a congenital lumbosacral transitional vertebra (LSTV). There are few studies that discuss the surgical management of Bertolotti’s syndrome. Here, we report long-term outcomes after resecting a pseudoarthrosis between the sacrum and L5 in two teenage patients, along with a review of literature. Case Descriptions: Surgical resection of a lumbosacral bridging articulation (LSTV type IIa) was performed in two patients, 15 and 16 years of age who presented with intractable back pain. The adequacy of surgery was confirmed with postoperative studies. In both patients, pain and functional status improved within 6 weeks and have remained improved at last follow-up. Conclusion: Surgical removal of a pathologic L5 transverse process fused to the sacral ala in two young patients with Bertolotti’s syndrome improved postoperative pain and increased overall function. Given the progressive nature of Bertolotti’s syndrome, surgical intervention in young patients should be considered to mitigate years of chronic pain and attendant morbidity.

scholarly journals Cross finger flap cover for fingertip injuries

2017 ◽  
Vol 3 (2) ◽  
pp. 164 ◽  
Author(s):  
Srinivasan Rajappa ◽  
Tarun Prashanth
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Full Range ◽  
Hand Injuries ◽  
University Hospital ◽  
Dash Score ◽  
Dominant Hand ◽  
Flap Viability ◽  
Flap Cover

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Fingertip injuries are the most common form of hand injuries. Restoration of the anatomy is a technical challenge and is one of the basic tenets of the management of fingertip injuries. The cross finger flap is simple and easy to do and is a very useful tool in reconstruction of the pulp of the finger. The project aimed to study the efficacy of cross finger flap in the coverage of fingertip injuries.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study was conducted on a prospective basis in Sri Ramachandra University Hospital in Chennai. The study period was from May 2013 to August 2016.  All adults who had fingertip injuries who had undergone cross finger flap cover were included in the study. Patients who had other flaps for reconstruction and who were lost for follow-up were excluded from the study. Preoperative parameters which were recorded were mechanism of injury, size of defect, size of the flap, location of donor site and method of coverage of secondary defect. Outcome measures recorded were flap viability, flap sensibility using two-point discrimination, range of motion of fingers, grip strength and presence of other complications</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">40 patients were included in the study. Six were lost for follow-up. Mean follow-up was 14 months.  All flaps survived. Full range of motion was obtained in 87% of patients. Average grip strength was 94% for dominant hand injuries and 78% for non-dominant hand injuries. Mean quick DASH score was 10.5. Mean two-point discrimination was 15.4 mm. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Cross finger flap is very effective for coverage of volar fingertip defects with minimal residual problems.</span></p>

737 Treadmill Friction Hand Injuries in the Pediatric Patient

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S200-S201
Author(s):  
Paulette Abbas ◽  
Mia Choe ◽  
Elika Ridelman ◽  
Beth A Angst ◽  
Justin D Klein ◽  
...  
Keyword(s):  
Surgical Management ◽  
Surgical Procedures ◽  
Surgical Intervention ◽  
Median Number ◽  
Hand Injuries ◽  
Home Exercise ◽  
Scar Management ◽  
Delayed Intervention ◽  
Clinic Visits

Abstract Introduction Pediatric friction hand injuries are prevalent, likely due to the increasing presence of home exercise equipment. While friction injuries often appear deeper on initial assessment, not all are treated surgically during the acute phase. We sought to characterize our experience with outcomes based on acute (&lt; 30 days) surgical intervention compared to delayed intervention. Methods Patients were queried from a single institution, verified pediatric burn center database. A retrospective chart review of pediatric patients (&lt; 18 years) over a 5 year period was performed. Data collected included demographics, treatment methods (acute vs. delayed), dressing type, scar management, and follow-up. Outcomes included additional surgical and non-surgical adjuncts to treat the sequela of injury. Results Our institution treated 23 treadmill hand injuries over the 5-year period. There was a slight predominance of female (n=13, 57%) vs. male (n=10, 43%) patients. Median age at injury was 2 years (IQR 1–3). Thirteen patients (57%) sustained an injury equivalent to a second degree burn and ten (43%) to third degree. Injuries were initially treated with silvadene (n=14) and/or xeroform (n=21). Involvement of left and right hands were equally divided and all injuries involved the digits. The median number of digits involved was 2 (range 1–4). The most commonly injured digits were the middle and ring fingers (19 each). Average length of stay was 14 hours. All but one patient followed-up with a median number of 4 clinic visits. All of these patients were reported as healed at time of last follow-up. Median time to healing was 31.5 days (IQR 29 – 58). Overall, 4 patients (17%) underwent acute surgical intervention with a median of 7 days from injury (IQR 1.75–13.5). Of these 4 patients, 2 (50%) required additional operations for scar management and 2 (50%) required non-surgical management. Of the 19 (83%) who did not undergo early surgical management, only 1 patient (6%) required a Z-plasty, 12 (63%) were managed with non-surgical intervention and 6 (31%) needed no further treatment after healing. Conclusions Pediatric friction hand injuries often affect multiple digits and lead to a median of 4 clinic visits. Our data suggest that early surgical intervention in this cohort did not minimize future surgical procedures or non-surgical management. Rather, delayed intervention appears to allow for fewer surgical procedures and similar non-surgical management. Larger studies are required to validate this finding; however, this data suggests that continued initial management with a combination of silvadene and xeroform may be a safe option. Applicability of Research to Practice Our study provides guidance in the evaluation and treatment of pediatric treadmill friction injury. This data supports delaying surgical interventions on these seemingly deep hand injuries.

The Pathological Features of Surgically Managed Adrenal Cysts: A 15-year Retrospective Review

2013 ◽  
Vol 79 (11) ◽  
pp. 1159-1162 ◽  
Author(s):  
Payam Saadai ◽  
Shalini Arora ◽  
Alexander J. Greenstein ◽  
Michael Lewis ◽  
Celia M. Divino ◽  
...  
Keyword(s):  
Surgical Management ◽  
Pathological Findings ◽  
Epithelial Cyst ◽  
Tissue Component ◽  
Adrenal Cyst ◽  
Postoperative Course ◽  
Patient Demographics ◽  
Hormonal Function ◽  
Cystic Component

Adrenal cysts are rare. Most are benign but some may contain malignancy. There are no established guidelines for their surgical management. The purpose of this study was to determine the pathological findings and likelihood of malignancy in hormonally inactive adrenal cysts after adrenalectomy. Using the pathology registries at two centers, we identified patients who underwent excision of an adrenal cyst between 1994 and 2009. Hormonally active cysts including pheochromocytomas were excluded. Charts were reviewed for patient demographics, presentation, surgical management, and postoperative course. Of 551 adrenalectomy specimens, 15 (2.7%) contained an inactive adrenal cyst or cystic component. Cysts were more likely to be in women (67%) and right-sided (73%). Three patients (20%) were symptomatic from their lesion. Laparoscopic adrenalectomy was performed in nine patients (60%). Pathology revealed eight hemorrhagic cysts, four lymphangiomas, one hemangioma, one epithelial cyst, and one metastatic pulmonary adenocarcinoma. Laboratory and radiographic workup are essential in determining whether adrenal cysts have hormonal function or a solid tissue component before adrenalectomy. Although nonfunctional adrenal cysts may contain malignancy, most are benign. It is reasonable to observe asymptomatic, nonfunctioning, benign-appearing adrenal cysts in patients in whom follow-up can be ensured.

The Importance of Primary Reconstruction in the Treatment of Blast Related Hand Injuries During Childhood

2019 ◽  
Vol 158 (03) ◽  
pp. 298-303 ◽  
Author(s):  
Nado Bukvic ◽  
Suzana Srsen Medancic ◽  
Harry Nikolic ◽  
Ana Bosak Veršic ◽  
Frane Bukvic ◽  
...  
Keyword(s):  
Primary Repair ◽  
Hand Injuries ◽  
Treatment Modalities ◽  
Body Region ◽  
Dominant Hand ◽  
Blast Injuries ◽  
Primary Reconstruction ◽  
Hand Burns ◽  
Serious Injuries

Abstract Introduction Blast injuries are common during wartime but are also related to various holiday festivals worldwide. Despite strict legislations, these devices still cause serious injuries leaving permanent disabilities. Children are affected in numerous cases with the hand being the most affected body region. The aim of our study was to profile the blast related hand injuries and to review treatment modalities that we used. Methods A retrospective study of patients treated for blast-devices related hand injuries between 2006 and 2015 was performed. Results 112 patient with blast related hand injuries were treated in our department during the 10-year period. Most of the patients were male. The dominant hand was injured in 83.9% of the patients. Associated injuries were observed in 14.3% of patients. 90 children were treated on an out-patient basis, mostly due to hand burns (86.7%) or uncomplicated blast injuries (13.3%). 22 children required hospitalization due to severe blast and crush injuries and amputations. Surgery was carried out as the urgent procedure and involved debridement with primary repair. In the case of amputations debridement and sufficient skin ensuring complete wound coverage was the procedure of choice. Conclusion Blast related injuries of the hand during childhood are frequent and can cause different and complex defects. Besides prevention of these injuries, primary reconstruction of the affected hand is of outmost importance in preventing long-term consequences.

Surgical management and follow-up of patients with cervical cancer: Survey of gynaecological oncologists in the UK

2012 ◽  
Vol 32 (6) ◽  
pp. 576-579 ◽  
Author(s):  
M. A. E. Nobbenhuis ◽  
L. Balasubramani ◽  
D. F. Kolomainen ◽  
D. P. J. Barton
Keyword(s):  
Cervical Cancer ◽  
Surgical Management ◽  
The Uk

Colorectal Cancer in the Young Patient

2007 ◽  
Vol 73 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Daniel R. Leff ◽  
Alvin Chen ◽  
David Roberts ◽  
Katherine Grant ◽  
Catherine Western ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Survival Rates ◽  
Young Patients ◽  
Relative Survival ◽  
Duration Of Symptoms ◽  
Relative Survival Rate ◽  
Tertiary Referral Center ◽  
The Uk ◽  
Worse Prognosis

Colorectal cancer is the second most common cause of death from cancer in the UK. It is estimated that between 2 to 3 per cent of colorectal cancer occurs in patients younger than the age of 40 years. It remains unclear from the literature whether this group of patients has a worse prognosis from colorectal cancer than the population as a whole. There are no large series that report a 10-year survival in young patients diagnosed with colorectal cancer. The authors’ objective was to assess patients diagnosed with colorectal cancer younger than the age of 40 years to determine whether the 5- and 10-year survival rates in a tertiary referral center compares favorably with survival rates obtained at other centers and the population as a whole. A retrospective observational study was conducted and an analysis of the patient's notes was made, specifically looking at age at diagnosis, nature and duration of symptoms, predisposing risk factors for colorectal cancer, the site within the bowel of the colorectal cancer, the type of curative resection performed, Dukes’ stage, and details of 5- and 10-year follow-up to assess survival. Forty-nine patients age 40 years or younger received treatment for colorectal cancer at St. Mark's Hospital from 1982 to 1992. The overall 5- and 10-year survival was 58 per cent and 46 per cent respectively. The study provides more evidence to support the fact that young patients with colorectal cancer seem to present with more advanced disease. Despite this, the overall 5-year relative survival rate is comparable if not better than other studies, supporting recent evidence that the prognosis in this group of patients is no worse than for colorectal cancer in the population as a whole.

Causes and Consequences of Hand Injury

1985 ◽  
Vol 10 (3) ◽  
pp. 288-292
Author(s):  
M. E. SMITH ◽  
J. M. AUCHINCLOSS ◽  
M. S. ALI
Keyword(s):  
Postal Questionnaire ◽  
Economic Consequences ◽  
Hand Injuries ◽  
Hospital Services ◽  
The United Kingdom ◽  
The Individual ◽  
Serious Injuries ◽  
Mean Time ◽  
At Home

Studies were carried out in Edinburgh to determine the nature, causes and economic consequences of hand injuries requiring more than one visit to hospital. Information on 236 out-patients was collected during a period of six weeks and on 122 in-patients during a period of six months. In both studies, follow-up was by postal questionnaire six weeks after injury. More serious injuries requiring admission to hospital occurred at home (39%) than at work (27%), and of injuries treated on an out-patient basis, the highest proportion (30%) happened at sport. As a result, demands on hospital services were highest in the later part of the day and evening. The main causes of injury were falls at home, at work, in the street or through violence, and only a few were caused by industrial machinery. Two-thirds of the patients were employed, and the mean time off work was three weeks for out-patients and seven weeks for in-patients. Although Edinburgh may not be typical of other cities in the United Kingdom, the studies suggest that even so-called ‘trivial’ hand injuries make considerable demands on hospital services, with related costs to the individual, the employer and the nation.

scholarly journals Long-term outcomes after surgery for catastrophic epilepsy in infants: institutional experience and review of the literature

2020 ◽  
Vol 26 (2) ◽  
pp. 157-164
Author(s):  
Vincent C. Ye ◽  
Ashish H. Shah ◽  
Samir Sur ◽  
Justin K. Achua ◽  
Shelly Wang ◽  
...  
Keyword(s):  
Young Patients ◽  
Intractable Epilepsy ◽  
Neurosurgical Procedures ◽  
Neurodevelopmental Outcomes ◽  
Mortality And Morbidity ◽  
Surgical Interventions ◽  
Patient Demographics ◽  
Institutional Experience ◽  
Catastrophic Epilepsy

OBJECTIVEUncontrolled epilepsy is associated with serious deleterious effects on the neurological development of infants and has been described as “catastrophic epilepsy.” Recently, there has been increased emphasis on early surgical interventions to preserve or rescue neurodevelopmental outcomes in infants with early intractable epilepsy. The enthusiasm for early treatments is often tempered by concerns regarding the morbidity of neurosurgical procedures in very young patients. Here, the authors report outcomes following the surgical management of infants (younger than 1 year).METHODSThe authors performed a retrospective review of patients younger than 1 year of age who underwent surgery for epilepsy at Miami (Nicklaus) Children’s Hospital and Jackson Memorial Hospital between 1994 and 2018. Patient demographics, including the type of interventions, were recorded. Seizure outcomes (at last follow-up and at 1 year postoperatively) as well as complications are reported.RESULTSThirty-eight infants (median age 5.9 months) underwent a spectrum of surgical interventions, including hemispherectomy (n = 17), focal resection (n = 13), and multilobe resections (n = 8), with a mean follow-up duration of 9.1 years. Hemimegalencephaly and cortical dysplasia were the most commonly encountered pathologies. Surgery for catastrophic epilepsy resulted in complete resolution of seizures in 68% (n = 26) of patients, and 76% (n = 29) had a greater than 90% reduction in seizure frequency. Overall mortality and morbidity were 0% and 10%, respectively. The latter included infections (n = 2), infarct (n = 1), and immediate reoperation for seizures (n = 1).CONCLUSIONSSurgical intervention for catastrophic epilepsy in infants remains safe, efficacious, and durable. The authors’ work provides the longest follow-up of such a series on infants to date and compares favorably with previously published series.

Rezidivrisiko nach thyreostatischer Behandlung immunogener und nicht-immunogener Hyperthyreosen

1990 ◽  
Vol 29 (01) ◽  
pp. 1-6 ◽  
Author(s):  
E. Voth ◽  
N. Dickmann ◽  
H. Schicha ◽  
D. Emrich
Keyword(s):  
Relapse Rate ◽  
Urinary Iodine ◽  
Young Patients ◽  
Antithyroid Drugs ◽  
Urinary Iodine Excretion ◽  
Old Patients ◽  
Primary Disease ◽  
Iodine Excretion ◽  
Immunogenic Hyperthyroidism

Data of 196 patients treated for hyperthyroidism exclusively with antithyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogeriic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p <0.001 and 83%, p <0.001, respectively). In patients with primary disease, clinical, biochemical and scintigraphic parameters were tested with respect to their capability of predicting a relapse. For immunogenic hyperthyroidism the highest relapse rates were observed in young patients and in those with large goitres, whereas for non-immunogenic hyperthyroidism they were highest in old patients, in those with nodular goitres and in those without an increased urinary iodine excretion at the time of diagnosing hyperthyroidism.

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