Brachiobasilic fistula formation - single versus two stage procedure.

BACKGROUND: Brachial basilic (BB) fistulae are a form of vascular access for patients requiring dialysis. They are indicated when the cephalic vein is unsuitable for use. This fistula can be created with either a single stage or a two stage procedure. We aimed to compare the two techniques. METHODS: 73 BB fistulae (29 single and 44 two-stage) were created over a 5-year period (2003-2008). Data including sex, age, dialysis and diabetic status was collected from the case notes. Patency and time to maturity data was collected prospectively on an electronic database within the dialysis unit. RESULTS: There was no significant difference in functional patency rates between the two methods. A significant difference was identified between patients who had their fistula created prior to starting dialysis compared to those who had their fistula created after starting dialysis, in both initial patency rate (p = 0.017) and long term survival of the fistulae (p = 0.002). CONCLUSION: We identified no significant difference of patency between the two methods. This implies that a single stage procedure has benefits, by offering a quicker form of vascular access. Patients who had their fistulae created prior to dialysis had improved patency rates.

Validation of the Glasgow Facial Palsy Scale for the assessment of smile reanimation surgery in facial paralysis.

OBJECTIVES: To evaluate the Glasgow Facial Palsy Scale as a tool to assess facial reanimation surgery in facial palsy. Software analysis of digital video data is used to measure facial movements, comparing the affected to the normal side. We present the first use of the Glasgow Facial Palsy Scale following facial re-animation surgery. DESIGN: A comparison of the Glasgow Facial Palsy Scale against the Nottingham scoring system. Subjects undergoing unilateral surgical smile reanimation procedures were selected. Comparison was made with the Nottingham facial palsy scale and the House-Brackmann Scale pre- and postoperatively. SETTING: Patients were recruited in the facial palsy clinic of Canniesburn Plastic Surgery Unit, Glasgow. PARTICIPANTS: Seven consecutive patients were selected who were due to undergo unilateral facial reanimation. MAIN OUTCOME MEASURES: The difference in pre- and post-surgical facial movement as measured using the Glasgow Facial Palsy Scale with this value being compared to that obtained using the Nottingham scoring system. Note was also taken of the correlation with House-Brackmann system and clinical correlation. RESULTS AND CONCLUSIONS: Statistical analysis indicated a linear relationship between the Glasgow Facial Palsy Scale and the Nottingham System. The Pearson correlation test was used to confirm the relationship between the two methods giving a result of -0.587, which indicates significant correlation between the two methods. We conclude that the Glasgow Facial Palsy Scale is a standardised objective method of assessing the change in facial movement following smile reanimation surgery. We commend it as a useful tool to objectively assess surgical results in this challenging field.

The role of iodine in the pathogenesis of thyroid enlargement in rats with chronic renal failure.

In rats with mild renal failure produced by a 2/3 nephrectomy on one side followed by a total nephrectomy on the other, ingestion of a high (10 mg/kg) iodine diet for two months resulted in thyromegaly, high serum iodine levels and a good correlation between thyroid weight and serum iodine (r = 0.75, P less than 0.01) or thyroid weight and blood urea nitrogen (r = 0.745, P less than 0.01). Iodine may potentiate the effects of unidentified gointrogens that accumulate in rats with renal failure. Since the serum iodine levels were higher in the animals with renal failure, it is also possible that iodine alone may have been responsible for the observed differences in thyroid weight.

Pleomorphic adenomas: post-operative radiotherapy is unnecessary following primary incomplete excision: a retrospective review.

BACKGROUND: Current standard treatment of Pleomorphic Salivary Adenoma (PSA) of the Parotid Gland is by surgical excision. The management of incomplete excision remains undecided with post-operative radiotherapy advocated by some and observation by others. METHODS: 190 patients who underwent resection of PSA of the parotid gland within the West of Scotland region from 1981 to 2008 were identified and data collected. RESULTS: 78/190 patients had a primary incomplete excision. 25/78 received post-operative radiotherapy and 53 were observed. Recurrences occurred in 11/53 in those observed and in 1/25 of those who received radiotherapy. 21/25 complained of significant side effects from the radiotherapy. 38 surgeons performed 190 procedures, with a range of experience from 1 to28 procedures. CONCLUSIONS: Radiotherapy does appear to reduce recurrence with incomplete excision, however it is associated with significant side effects. We therefore feel radiotherapy should not be routinely recommended. Subspecialisation should be adopted to increase the operating surgeon's experience.

Assessing angulation on digital images of radiographs of fractures of the distal radius: visual estimation versus computer software measurement.

We assessed the reliability of visual estimation of angles on computer images of radiographs, and compared their accuracy with the measurement of angles using computer software for ten distal radius fractures. We asked 73 clinicians to visually estimate the dorsal angulation on ten computerized radiographs of fractures of the distal radius. The reliability of these estimations was calculated. Their accuracy was compared to a 'gold standard' obtained by consensus agreement between three consultants measuring these angles using the software. Inter-observer reliability was calculated as ICC = 0.51 and intra-observer reliability as r = 0.76. The visual estimations were less accurate with a mean percentage error of 31% (range, 7-83%). As angulation increased the estimation accuracy improved. Although reliability and accuracy of such estimation was better for clinicians with greater experience, actual measurement was more reliable and accurate.