The effects of Scaphoid and Colles casts on hand function.

Although necessary for bone healing, immobilisation temporarily prevents hand function and may necessitate corrective physiotherapy later. Scaphoid and Colles casts are both commonly used to immobilize scaphoid fractures. Non-union rates are comparable with both casts. The Scaphoid cast incorporates the thumb, whereas the Colles cast leaves the thumb free. We compared the effect of the two casts on hand function in 20 healthy right-hand-dominant volunteers using the Jebsen-Taylor Hand Function Test. Data were obtained through a mixed between and within subject design. Both casts prolonged the time taken to complete the hand function test compared to controls. Testing in the Scaphoid cast took significantly longer than in the Colles cast.

Management of the surgical patient with asthma.

"Asthma is a common and chronic inflammatory condition of the airways whose cause is not completely understood. As a result of inflammation the airways are hyperresponsive and they narrow easily in response to a wide range of stimuli". There are almost 3 million asthma sufferers in the UK with up to 5% of adults and 5-10% of children having asthma. It is not surprising then that a significant number of patients who come into hospital for either elective or emergency surgery will be asthmatic.

Peri-operative care of the patient with diabetes mellitus.

There are a number of factors to take into consideration when a patient with diabetes has to have an operation. Care of the patient with diabetes is tailored to individual needs and this care needs to extend right through their time in hospital, including pre-operative, peri-operative and post-operative care. This paper examines the rationale for care of the diabetic patient in the operating department and will suggest a protocol for through theatre care.

Intraoperative pressure sore prevention.

It was once believed that pressure sores were a ward based, nursing problem. However, operating tables are relatively hard and the anaesthetised patient is at particular risk for a number of reasons with the overall incidence of pressure sore formation during operation identified at 12%. Unfortunately in the past very few pressure relieving devices have been available for use in this particular area. The main problems encountered by patients whilst in the operating theatre arise because of the pressures between the patient and the operating table, mainly because of the patient's own weight but also that exerted by the surgeon. A limited number of studies have been carried out on the incidence of theatre induced pressure sores. Others have focused on actual pressures created by operating tables and the factors which may influence an increase in those pressures. Some authors have also researched the effectiveness of a number of pressure relieving devices specifically designed for use in the operating theatre.

Influence of arterial disease, age and active ulceration on venous refilling time measured by photoplethysmography.

This study investigated the influence of arterial disease, patient age and the presence of a venous ulcer on venous refilling time as measured by photoplethysmography. Refilling time was evaluated in 157 control limbs, in 133 limbs with venous disease, in 17 limbs with arterial disease and in 20 limbs with mixed disease (arterial and venous disease) as the cause of ulceration. Refilling time reduced progressively with age in control subjects and was significantly shorter over the age of 50 years. Limbs with venous disease alone had a significantly shorter refilling time when compared with controls (Mann-Whitney U test, P < 0.01); however, there was no alteration in refilling time with age. Limbs with arterial disease, without clinical evidence of venous insufficiency, had a shorter refilling time when compared with controls but a longer refilling time compared with those with venous disease (P < 0.01). The refilling time in patients with mixed ulcers did not differ from those with venous ulcers (P < 0.265). Refilling time measured when an ulcer was present was not significantly different to that measured after the ulcer had healed (P = 0.59). Venous refilling time normally reduces with age but is not affected by arterial disease or the presence of an ulcer.