RESUMEN
INTRODUCTION AND IMPORTANCE: Basosquamous carcinoma (BSC) is a rare cutaneous cancer defined as a basal-cell carcinoma that has differentiated into a squamous-cell carcinoma. It is aggressive and infiltrative, and known for its multiple recurrences and risk for metastasis. CASE PRESENTATION: This article describes the case of a 78-year-old man who presented with a several-year history of an infiltrative BSC of his chest-wall invading into his sternum. CLINICAL DISCUSSION: He was subsequently treated surgically with a chest-wall wide-local excision and sub-total sternectomy, reconstructed with titanium plates and a musculocutaneous anterolateral thigh free-flap. CONCLUSION: This case highlights a surgical approach to advanced chest-wall BSC.
RESUMEN
PURPOSE: This study assesses the influence of A2 pulley integrity on the strength of the repair. METHOD: Part 1- The flexor digitorum profundus (FDP) tendons of 72 Cobb chicken feet were severed and repaired in the region of the A2 pulley using a modified Kessler core suture and an epitendinous suture. The A2 pulley was either left intact, divided for 50% of its length, or divided in its entirety. The distal interphalangeal joint was fixed at a position of 20°, 40° or 60° of joint flexion. The load to failure, integrity of the A2 pulley and the site of tendon failure were analysed. Part 2- A further 32 chicken feet were used to exclude the effects of freezing and thawing on results and to analyse differences when using a core suture only. RESULTS: No difference in failure load between any of the test groups or subgroups was identified. The integrity of the A2 pulley was preserved in all specimens. The most common cause of failure was distal suture pull-out. DISCUSSION: This study does not demonstrate that release of the A2 pulley provides an advantage in increasing tendon repair strength. Division of 50% of the A2 pulley does not predispose to pulley rupture. Flexor tendon repair strength did not alter with distal interphalangeal joint flexion between 20° and 60°. CLINICAL RELEVANCE: The findings of this study do not support division of the A2 pulley to prevent flexor tendon repair failure if repair methods of appropriate strength are utilised.
Asunto(s)
Pie , Procedimientos de Cirugía Plástica/métodos , Traumatismos de los Tendones/fisiopatología , Traumatismos de los Tendones/cirugía , Tendones/fisiopatología , Tendones/cirugía , Animales , Fenómenos Biomecánicos , Pollos , Modelos Animales , Técnicas de Sutura , Resistencia a la Tracción/fisiología , Soporte de Peso/fisiologíaAsunto(s)
Aerosoles/efectos adversos , Quemaduras Químicas/epidemiología , Quemaduras Químicas/etiología , Explosiones , Adolescente , Adulto , Distribución por Edad , Unidades de Quemados , Quemaduras Químicas/fisiopatología , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Artículos Domésticos , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Presión , Medición de Riesgo , Distribución por Sexo , Adulto JovenRESUMEN
BACKGROUND: Despite being essential to patient care, current clinical handover practices are inconsistent and error prone. Efforts to improve handover have attracted attention recently, with the ISBAR tool increasingly utilised as a format for structured handover communication. However, ISBAR has not been validated in a junior medical officer setting. OBJECTIVE: To assess the effect of the ISBAR handover tool on junior medical officer (JMO) handover communication in an Australian hospital. METHODS: JMOs who participated in after-hours handover during an 11 week clinical term from June to August 2009 were recruited. After-hours handover was audiotaped, and JMOs completed a survey to assess current handover perception and practice. JMOs then participated in a 1 h education session on handover and use of the ISBAR handover tool, and were encouraged to handover using this method. Following the education session, participants were surveyed to measure perceived changes in handover with use of ISBAR, and handover was again audiotaped to assess differences in information transfer and duration. RESULTS: Following the introduction of ISBAR, 25/36 (71%) of JMOs felt there was an overall improvement in handover communication. Specifically, they perceived improvement in the structure and consistency of handover, they felt more confident receiving handover, and they believed patient care and safety were improved. Audio-tape data demonstrated increased transfer of key clinical information during handover with no significant effect on handover duration. CONCLUSIONS: Use of the ISBAR tool improves JMO perception of handover communication in a time neutral fashion. Consideration should be given to the introduction of ISBAR in all JMO handover settings.
