RESUMO
Venepuncture may be associated with nerve injuries and is commonly performed at the median cubital vein (MCV). Injuries to the superficial radial nerve at the wrist and to the median nerve, anterior and posterior interosseus nerves and medial and lateral cutaneous nerves (LCN) of the forearm at the cubital fossa have been reported. The LCN is a sensory branch of the musculocutaneous nerve and the position of the nerve in relation to the MCV is variable within the cubital fossa. The LCN supplies sensory innervation to the C6 dermatome corresponding to an area of skin overlying the radial border of the forearm. We report the case of a 30-year-old right-handed woman who presented with loss of sensation in the left forearm after donating blood at a transfusion centre. This was due to an injury of the LCN. After 3, 18 and 36 months of follow-up, the sensory deficit had only improved minimally. The lack of recovery of the sensation after 36 months indicates a permanent nerve injury such as neurotmesis rather than neurapraxia of the LCN. A thorough knowledge of the clinical anatomy of the MCV and the LCN, which is highlighted, is essential in preventing venepuncture-associated nerve injury.
Assuntos
Doadores de Sangue , Cateterismo/efeitos adversos , Antebraço/irrigação sanguínea , Antebraço/inervação , Traumatismos dos Nervos Periféricos/etiologia , Adulto , Feminino , Seguimentos , Humanos , Traumatismos dos Nervos Periféricos/diagnóstico , Recuperação de Função Fisiológica , Sensação , Fatores de TempoRESUMO
Congenital midline cervical clefts (CMCC) is a clinical diagnosis and represents a spectrum of rare developmental anomalies. Fewer than 100 cases have been reported overall, the first being described by Bailey in 1924 (1). It is not a true cleft because it does not include a gap between adjacent skin flaps. It is thought to represent a failure of midline fusion of the branchial arches although this is controversial. It is a clinical diagnosis and presents at birth with a ventral midline defect of the skin of the neck. This consists of a skin tag (nipple-like projection), an atrophic mucosal surface and a caudal sinus. It may be associated with a subcutaneous fibrous cord, which can cause a vertical midline tethering restricting cervical extension. Associated defects may be a median cleft of the mandible, tongue and lower lip. There may be an associated delay in mandibular development and hypoplasia or absence of neck structures such as the hyoid bone. Associated thyroglossal and bronchogenic cysts may occur as well as defects in other parts of the body such as a sternal cleft (2). CMCC has been previously reported in the literature as being of a branchial origin, however a review of the histology of previous cases suggests a combined branchial and bronchogenic component (2-6). We report on two cases that presented with the clinical picture of a classical CMCC. Our first case appears to have a bronchogenic origin with possible branchial components and the second case appears to be solely branchial in origin. There is much debate as to the embryology of this clinical entity; we shall endeavour to address the main theories.
Assuntos
Branquioma/embriologia , Branquioma/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Branquioma/patologia , Feminino , Humanos , Recém-Nascido , MasculinoRESUMO
OBJECTIVE: The purpose of this study was to determine the extent of multidisciplinary care and audiological services rendered to children with CL/P who underwent surgical repair of the cleft in 1998 and 1999. This followed proposals to radically reorganize cleft lip and palate services in the U.K. after unsatisfactory findings in a national review. METHOD: Information was obtained from questionnaires sent to clinicians (audiologists; ear, nose, and throat surgeons; and community pediatricians) from audiology teams, and parents were asked to retrieve information from their Personal Child Health Record. Standards chosen were based on the Clinical Standards Advisory Group, the South Thames Audiology Audit Group, and the National Deaf Children's Society. RESULTS: None of the agreed standards were achieved at an acceptable level. CONCLUSIONS: This demonstrates the need for better communication systems between teams, including better use by parents and professionals of the Personal Child Health Record. A clinical care pathway is suggested here with other recommendations.
Assuntos
Fissura Palatina/complicações , Transtornos da Audição/cirurgia , Prontuários Médicos/normas , Ventilação da Orelha Média/estatística & dados numéricos , Otite Média com Derrame/cirurgia , Serviços de Saúde da Criança/organização & administração , Fenda Labial/complicações , Bases de Dados Factuais , Feminino , Transtornos da Audição/diagnóstico , Transtornos da Audição/etiologia , Testes Auditivos , Humanos , Recém-Nascido , Masculino , Auditoria Médica , Otite Média com Derrame/etiologia , Equipe de Assistência ao Paciente , Estudos Retrospectivos , Reino UnidoRESUMO
BACKGROUND: Hampshire et al. (2004) have recently reported on the variation in use of the Personal Child Health Record (PCHR) (The Red Book). This study aims to add further data to the discussion. OBJECTIVE: To estimate the proportion of parents bringing the Red Book to a hospital surgical outpatient appointment. METHODS: An audit was performed over 4 months ending 14 July 2004. This involved the author noting whether parents brought the Red Book to the Paediatric Plastic and Reconstructive Surgery clinics, on different sites and including specialist multidisciplinary clinics. 200 consecutive attendees were reviewed.
Assuntos
Prontuários Médicos , Pacientes Ambulatoriais , Adolescente , Fatores Etários , Atitude Frente a Saúde , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pais/psicologia , Equipe de Assistência ao Paciente , Cirurgia PlásticaRESUMO
The development of a basal cell carcinoma within a naevus sebaceous of Jadassohn (NSJ) has commonly been reported. However, the development of a squamous cell carcinoma (SCC) is rare. There have been several reports of SCC arising within a NSJ but many contain little or ambiguous clinical information. A thorough review of the current English language literature has identified only three other well documented cases of SCC arising in a NSJ. Of these only one was a case of simultaneous occurrence of squamous and basal cell carcinoma. We report the second case of both malignancies arising within the same NSJ.
Assuntos
Carcinoma Basocelular/etiologia , Carcinoma de Células Escamosas/etiologia , Neoplasias Primárias Múltiplas/etiologia , Nevo/complicações , Neoplasias das Glândulas Sebáceas/complicações , Adulto , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Humanos , Masculino , Neoplasias Primárias Múltiplas/patologia , Nevo/patologia , Neoplasias das Glândulas Sebáceas/patologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologiaAssuntos
Adjuvantes Farmacêuticos/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Conservantes Farmacêuticos/efeitos adversos , Vacinas/efeitos adversos , Hidróxido de Alumínio/efeitos adversos , Antibacterianos/efeitos adversos , Granuloma/induzido quimicamente , Humanos , Queloide/induzido quimicamente , Vacinação/efeitos adversos , Vacinação/métodos , Vacinas/químicaAssuntos
Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Músculos Palatinos/cirurgia , Insuficiência Velofaríngea/cirurgia , Pré-Escolar , Fissura Palatina/complicações , Fissura Palatina/patologia , Humanos , Lactente , Avaliação de Resultados em Cuidados de Saúde/métodos , Insuficiência Velofaríngea/complicações , Distúrbios da Voz/etiologia , Distúrbios da Voz/cirurgiaAssuntos
Serviços de Saúde da Criança/organização & administração , Fenda Labial/embriologia , Fenda Labial/cirurgia , Fissura Palatina/embriologia , Fissura Palatina/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Pré-Escolar , Fenda Labial/genética , Fissura Palatina/genética , Humanos , Lactente , Recém-Nascido , Programas Nacionais de Saúde/organização & administração , Política , Medição de Risco , Reino UnidoRESUMO
An unusual case of a female infant with Catel-Manzke syndrome is presented. Additional features not previously reported include three accessory ossicles at the bases or associated with the proximal phalanx of the index, middle, ring and little fingers bilaterally. There are also numerous bony abnormalities in both feet. Previous cases have shown no more than 2 accessory ossicles in the hand and these usually involve the index alone. The foot abnormalities are more extensive than any previously seen in this syndrome. This is only the 8th female case out of a total of 27 reported cases.
Assuntos
Deformidades Congênitas do Pé/fisiopatologia , Deformidades Congênitas da Mão/fisiopatologia , Pré-Escolar , Feminino , Deformidades Congênitas do Pé/diagnóstico por imagem , Deformidades Congênitas da Mão/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Radiografia , SíndromeRESUMO
We report the rare finding of a complete cleft of the secondary palate in the presence of a synechial band running from the incisive foramen over the tip of the tongue, terminating in the midline of the floor of the mouth.
Assuntos
Fissura Palatina/complicações , Fissura Palatina/cirurgia , Língua/anormalidades , Língua/cirurgia , Fissura Palatina/patologia , Feminino , Humanos , Recém-Nascido , Língua/patologiaRESUMO
A case of an anomalous muscle found in the right wrist of a 52-year-old man during routine carpal tunnel decompression surgery is reported. The muscle was observed lying transversely across the carpal tunnel superficial and parallel to the flexor retinaculum. Its further definition was subsequently demonstrated by postoperative magnetic resonance imaging (MRI). No similar structure was detectable on MRI of the left wrist.