Middle-phalanx-base radiographic morphology and its clinical implications.

The aim of this study was to establish normative values for the teardrop angle at the base of the middle phalanx. Our results showed a consistent mean teardrop angle in the range of 50°-51°, with no statistically significant difference observed between digits.Level of evidence: III.

Time to Resolution of Triggering after Steroid Injection for First Presentation Trigger Digits.

Background: Steroid injection is a proven treatment for trigger digits. The time taken for resolution of triggering following an injection is a question often asked by patients and one that has not been adequately addressed in existing literature. The aim of this study was to determine the time taken for triggering to resolve after a single steroid injection in patients presenting for the first time with a trigger digit. Methods: A prospective study was conducted in patients with first presentation of a grade II or grade III trigger digit(s) that received a steroid injection. Data with regards to age, gender, digit(s) involved, duration of symptoms, trigger grade, and presence of diabetes were collected. They were given a stamped addressed postcard with instructions to fill in the date that the triggering resolved and mail the postcard back to us. If the postcard was not received at three weeks, we contacted the patient by telephone to ask for the date of resolution of trigger. Results: 56 patients with 66 trigger digits were included in the study. 52 out of 66 digits (79%) had resolution of the trigger at one month. The mean duration for resolution of trigger was 8.8 days (range 1-30 days). Conclusions: Patients can be counselled that a steroid injection is effective in resolving the trigger in 79% of trigger digits presenting for the first time and that the mean time taken for resolution of triggering is 8.8 days. It is recommended to wait for at least one month before considering another injection or alternative treatments.

Antegrade Flow Digital Artery Flaps.

Antegrade flow digital artery flaps enjoy a reputation for versatility and reliability with a robust vascular pedicle and the capability of resurfacing small to moderate sized defects in virtually any part of the hand. More than five decades of experience and evolution of surgical techniques with this class of intrinsic hand flaps makes this an indispensable part of the hand surgeons armamentarium when it comes to soft tissue reconstruction in the hand. Variant techniques and variable resurfacing indications are described for these class of flaps in this article. The main disadvantage or limitation lies in the need to sacrifice a digital artery.

First impressions last A survey of knowledge of first aid in burn-related injuries amongst hospital workers.

RATIONALE: The administration of first aid in burns has been shown to have a significant influence on the ultimate severity of the burn. We wanted to assess in-hospital healthcare (HCW), and non-healthcare workers' (nHCW) knowledge of first aid in burns. METHODS: A purpose-designed questionnaire, including information about previous attendance at a first aid course and four clinical scenarios of burns, was distributed to HCWs in the local hospitals and non-medical students in the Universities of Leeds and Sheffield. RESULTS: 697 questionnaires were completed - 397 (57%) from HCW and 300 (43%) from nHCW. 59% of HCW had attended a first aid course, 68% of these courses included teaching on first aid in burns. HCW who had completed a first aid course generally did better than those who had not. Only 16% of HCW achieved correct answers in all questions compared to 30% nHCW. CONCLUSIONS: We show that the knowledge of first aid in burns is relatively poor amongst HCW and that attendance at a burns first aid course improves knowledge (although perhaps not as much as one might hope). We recommend that the burns content of first aid courses be reviewed, and that there is a requirement for ALL hospital healthcare workers to undertake a first aid course, which includes appropriate burns first aid.

Visceral Leishmaniasis presenting with intestinal failure: a case report and literature review.

We describe an unusual case of visceral Leishmaniasis affecting the gastrointestinal tract in a young immunocompetent patient whose only recent foreign travel was a trip to Mexico 9 months previously. She presented insidiously with diarrhoea, weight loss and developed subacute intestinal failure. Interestingly, she lacked most of the typical features of acute infection, including visceromegaly, fevers and hypergammaglobulinaemia. Atypical visceral involvement involving the gastrointestinal tract is well recognized in HIV coinfection, but very rare in immunocompetent patients. Repeated microscopy and culture of endoscopic biopsies failed to identify Leishmania parasites. Serological tests - direct agglutination test and anti-K39 antibody tests - were negative. This case highlights a very rare presentation of the condition with the absence of other visceral involvement and diagnosis being eventually made solely on polymerase chain reaction of rectal tissue, with a subsequent excellent response to therapy with intravenous liposomal amphotericin.