Hair-thread tourniquet syndrome: a case report and literature review.

Though widely reported, Hair-thread Tourniquet Syndrome (HTTS) is poorly recognized. It refers to external, mechanical, circumferential constriction of an appendage, typically with an end-artery such as a digit, resulting in a "compartment syndrome-like" situation. HTTS is illustrated using the case of an infant. Children presenting with irritability should have their digits examined for signs of strangulation, with the awareness that numerous strands may be involved, with some buried in the skin. Early surgical-release must be performed if unwinding or simple cutting is unsuccessful.

A simple idea for approximating the volume of filler needed for chest-wall contour-defects.

Fillers can be used to correct contour-defects. Due to the irregularities of defects, estimating the volume of filler required can be difficult. This frequently results in surgeons taking a step-wise approach to filler-injection, usually occurring over different appointments. Using a patient with pectus excavatum as an example, we provide a simple tip as to estimating the volume of filler required. In this case, normal saline was poured into the chest-wall defect until the adequate level was reached (from the lateral aspect), while noting how much liquid was used. The patient then had a comparable volume of filler injected.

Extracranial-intracranial bypass of the bilateral anterior cerebral circulation using a thoracodorsal axis artery-graft.

Bilateral extracranial-intracranial (EC-IC) bypass-grafting of the cerebral circulation is uncommon. We report a case of anterior cerebral artery EC-IC bypass using the thoracodorsal axis artery-graft. The bifurcation of the thoracodorsal axis allows bypass of both anterior hemispheres, while matching appropriate small-vessel dimensions.

Microscopy, culture, and sensitive management of uncomplicated urinary tract infections in adults in the primary care setting.

The high prevalence of urinary tract infections (UTIs) places a significant burden on healthcare systems. Clinicians may over-manage the issue, and there is great variability in practice, with economic- and resource- implications. Up to 40% of patients with a suspected UTI do not have an infection. Using PubMed (Medline) to shortlist relevant papers in English from the last 30 years, and further sub-selection to include only uncomplicated UTIs in adults in primary care, we reviewed the literature pertaining to uncomplicated UTIs, and how it should be managed efficiently in the primary care setting. In general practice, there is no advantage to routinely request microscopy and culture of urine samples in the presence of an appropriate history and urinalysis reagent-strip testing. If antibiotics are required, then a 3-day course shall suffice. Larger epidemiological studies focusing on more susceptible sub-populations may provide better guidance for discriminatory factors to produce an algorithm for treatment.

Skin cleansers: the risks of chlorhexidine.

The potential dangers of chlorhexidine must be conveyed to the medical community. Health care professionals have little knowledge about the side effects and complications that may arise from this increasingly used compound. The suggestions in this case study may help to reduce the risk of adverse effects.

Cavi-Care: a forgotten dressing?

The 'ideal wound dressing' obviously depends on the requirements of the wound in question. Nevertheless, dressing characteristics that commonly facilitate an optimum healing environment are: The ability to adapt to wound position, size, depth and shape Being of high comfort; Being soft, with a moist wound interface Providing an effective barrier against exogenous microbes Being of competitive cost Having the ability.

The World Health Organization's 'Surgical Safety Checklist': should evidence-based initiatives be enforced in hospital policy?

OBJECTIVES: To assess the awareness and voluntary usage of the World Health Organization's Surgical Safety Checklist (WHO SSC), just prior to its mandatory implementation. DESIGN: Questionnaire-based, prospective, telephone survey. SETTING: Patients are exposed to systematic risks and principles of surgical safety are inconsistently applied even in sophisticated settings. The evidence-based WHO SSC addresses shortfalls to promote patient safety. It was formally introduced in the United Kingdom in January 2009 and became a mandatory preoperative requirement in all hospitals from February 2010. PARTICIPANTS: Two hundred and thirty-eight hospitals, both private and government-run, in the UK. MAIN OUTCOME MEASURES: Appreciation among senior theatre personnel as to the existence, implementation and usage of the WHO SSC concept. RESULTS: Almost all had heard of the SSC, but in only two-thirds of hospitals was its use mandatory. Where the SSC was not compulsory, 80% were using it informally or sporadically. One-quarter of senior theatre personnel in hospitals without compulsory use indicated they did not know or that their department did not plan on using the checklist in the next six months, despite the deadline for implementation. CONCLUSIONS: If the SSC is to optimize safety, then greater education and awareness is required.

Educating on CS or 'tear gas'.

Chlorobenzalmalononitrile or 2-chlorobenzylidene malononitrile (CS) is a commonly used riot control agent. Although generally deemed to be safe for this application, it is known that CS can cause a number of adverse effects in those exposed to it. Understanding its properties and its side effects is important in ensuring optimal medical management of its complications and, indeed, this principle applies to every chemical. As the need for CS and other law enforcement devices increases, it is important for the emergency medicine team and other specialties to be aware of correct management protocols.

Chlorhexidine's complications.

Chlorhexidine is an effective cleansing skin-preparation agent and has many user benefits. It has, however, been associated with a number of complications which are highlighted in this paper. All users of chlorhexidine must be aware of these risks and employ insightful use of this chemical.