Representation of plastic and cosmetic surgeons in British newspapers.

BACKGROUND: The aim of this study was to investigate the use of the terms "plastic surgeon" or "cosmetic surgeon" in British newspapers. METHODS: Based on readership volume, the top eight British newspapers were searched for articles written between 09/2016-09/2021 for their use of keywords "plastic surgeon" OR "cosmetic surgeon". The names of the doctors referenced were searched in the GMC register to determine their speciality registration. RESULTS: A total of 2326 articles were read. 2107 (91%) articles were excluded as they did not refer to a specifically named doctor. Of the 219 articles remaining, 136 referenced "plastic surgeons". 22 (16%) doctors referred to as "plastic surgeons" were not on the GMC speciality register for plastic surgery. 83 articles made reference to "cosmetic surgeons". 39 (47%) were on the plastic surgery register but 11 (13%) were on other higher surgical registers [ENT (2) and ophthalmology (9)]. 18 (22%) cosmetic surgeons were registered as GPs and 15 (18%) were not on any speciality register. DISCUSSION: There is mis-representation of individuals performing cosmetic procedures as plastic surgeons regardless of their speciality or training. This prevents public awareness of the true scope of plastic and reconstructive surgery as a speciality in its own right.

Establishing scald prevention measures in UK maternity units from takeaway drinks.

AIM: To identify policies on the consumption of hot drinks by patients and visitors on all perinatal and postnatal wards in the United Kingdom, and to seek the opinions of members of the wider burns MDT as to whether standardised patient education or regulation of hot drinks around newborn babies is required. METHODS: All maternity units with postnatal wards across the United Kingdom were surveyed to establish availability of hot drinks on site and whether these were permitted on postnatal wards around infants. An online questionnaire was distributed to members of the British Burn Association to ascertain opinions on hot drinks policies. RESULTS: Hot takeaway drinks were permitted around newborn infants in 194 of surveyed postnatal wards and were only banned by two units. The online survey received 49 responses from different members of the British Burn Association. Thirty responders (61%) supported a takeaway hot drink ban, while those against the policy would alternatively encourage patient education, dedicated drinking areas and introduction of safety measures. CONCLUSIONS: Almost every postnatal unit in the UK has access to hot drink retailers on site allowing parents and visitors to bring them into close contact with babies. With varying local regulations, this poses potentially serious consequences during feeding or carrying. We propose a standardised antenatal education be made available, together with standardised designated areas on wards for parents and visitors to consume hot drinks away from infants.

Corrosive attacks in the UK - Psychosocial perspectives and decontamination strategies.

Acid attacks, or vitriolage, are defined as violent assaults involving the deliberate throwing of an acid or similarly corrosive substance with the intention to "maim, disfigure, torture or kill" [1]. The Acid Survivors Trust International suggest a prevalence of 1500 attacks reported worldwide per annum, although this is likely to be an underestimate by 40% [2]. The UK is thought to have one of the highest of rates of recorded corrosive attacks, with an increase from 228 attacks in 2012 to 601 in 2016. Most were reported by the London Metropolitan police force followed by Northumbria, Cambridgeshire, Hertfordshire, Greater Manchester and Humberside [[2]]. The chemical agents involved include acids, alkalis, oxidising and reducing agents, alkylating and chelating agents and solvents. They cause injury by producing a chemical interaction which can lead to extensive tissue destruction and extreme pain. Herein, we present a review on the changing epidemiology of corrosive attacks in the UK and currently employed management strategies.

Temperature dissociation of liquids in reusable thermoplastic containers-An eco-friendly scald risk?

Recent global concern regarding the impact of plastic waste on the environment has resulted in efforts to utilise reusable drink containers. Research is lacking regarding temperature dissociation of drinks in reusable thermoplastic cups. This study aimed to compare the cooling time of two common hot drinks sold at a UK retailer, in the three vessels they are sold; ceramic, disposable paper (with and without lid) and reusable thermoplastic cups (with and without lid). All temperatures were collated from 250 ml volumes of black Americano coffee or café latte in the three different containers. The cooling time was measured every sixty seconds using a standardised digital thermocouple thermometer until a threshold liquid temperature of 43 °C was reached. All experiments were performed in triplicate and temperatures converted to a dimensionless logarithmic scale prior to statistical analysis. Cooling time was significantly slower for lidded cups irrespective of material. Unlidded thermoplastic cups significantly slowed cooling times for both black Americano coffee and café latte compared to ceramic and unlidded disposable paper cups. The growing trend in reusable cups does not in itself pose an increased risk of scald injury. However, we consider that the potentially increased ambulatory behaviour associated with using a lidded rather than unlidded cup may increase scald risk. We propose that further consumer guidance should be disseminated regarding the use of any lidded takeaway container to prevent scalds in both adults and children.

Is it time for a change in the approach to chemical burns? The role of Diphoterine® in the management of cutaneous and ocular chemical injuries.

A multitude of household and occupational compounds have the potential to induce chemical burns to the eye and skin. Without prompt intervention, irreversible visual loss and disfigurement may prevail. Diphoterine® and Hexafluorine® are amphoteric and hypertonic chelating solutions used in the management of general chemical and hydrofluoric acid burns, respectively. They rapidly neutralise both acid and alkali agents without heat release and limit diffusion, making them superior to water irrigation alone. However, although Diphoterine® and Hexafluorine® uptake is slowly increasing in industrial workplaces, there is a paucity of education and use in both emergency departments and plastic surgery units worldwide. Herein, we present a case report of combined ocular and cutaneous acid burn treated with Diphoterine®, together with a review of the current supporting literature.

Electrochemotherapy treatment of a recalcitrant earlobe keloid scar with chronic lymphocytic leukaemia infiltration.

Electrochemotherapy, a tumour ablation modality, which facilitates intracellular delivery of poorly-permeable cytotoxic drugs, such as bleomycin, has shown promising results in the treatment of cutaneous and subcutaneous melanomatous and non-melanomatous metastases. We report the case of a 52-year-old Caucasian gentleman with a keloid scar to his left earlobe that developed following a piercing. Despite multiple intralesional steroidal injections, five intralesional excisions and a course of superficial radiotherapy the keloid scar remained over nine years later. For 15 years the patient had also suffered chronic lymphocytic leukaemia with no nodal disease or systemic involvement. However, histological analysis of the final surgical excision specimen showed chronic lymphocytic leukaemia infiltration of the keloid scar. Further surgical excision seemed unwise considering the recalcitrance of the keloid scar. Additionally, no systemic chemotherapy treatment options were feasible. Electrochemotherapy was performed under local anaesthesia with the aim of eradicating the chronic lymphocytic leukaemia deposit within the keloid lesion. Four sessions of electrochemotherapy using bleomycin were deployed over 11 months. A deep core biopsy of the treated keloid performed three months following the last electrochemotherapy session showed no evidence of chronic lymphocytic leukaemia. Serendipitously, following the initial electrochemotherapy treatment no further growth of the keloid scar was observed. Furthermore, subsequent electrochemotherapy led to a substantial reduction in size of the keloid sustained for 14 months at last follow-up. This report highlights the exciting potential of electrochemotherapy and bleomycin in the treatment of recalcitrant scars. Larger, well-designed clinical and in-vitro studies are required to further elucidate the exact role, mechanism and cost-effectiveness of electrochemotherapy in this area.

Caso pediátrico de un tumor de células granulares / Case report: paediatric case of a granular cell tumor

El tumor de células granulares es un tumor de tejidos blandos que raramente se manifiesta en niños. Actualmente se le considera originario de la vaina nerviosa y de etiología poco clara. Su escasa frecuencia de aparición en la población infantil hace que su diagnóstico se retrase. Su tasa de malignidad es 1-2%, con una recurrencia de 80%, lo que hace necesaria su exéresis completa. Presentamos el caso de una niña de 10 años con esta condición que nos recuerda la importancia de la inclusión en el diagnóstico diferencial de esta anómala lesión cutánea nodular (AU)

Granular cell tumour is an uncommon soft tissue tumour that rarely presents in children. These tumours are now accepted as being of nerve sheath origin and the aetiology is not clear. It seems that the childhood presentation of granular cell tumours is rare and diagnosis is usually delayed. Malignancy accounts for 1-2%, but complete excision is necessary due to the high rate of recurrence. We present a case in a ten-year-old girl to illustrate this condition and to remind about its inclusion in the differential diagnosis of strange looking nodular skin lesions (AU)

Evaluation of the ruby 694 Chromos for hair removal in various skin sites.

Lasers have been established as effective treatment for hair removal, with possible long-term suppression of hair growth in treated areas. The purpose of this study was to assess long-term hair regrowth after treatment with the ruby laser. Volunteers recruited into the 1997-99 study were divided between three treatment groups, each having left and right treatment sides. Two treatments were given on both sides at monthly intervals. A third treatment was given randomly to one side. Hair counts of the experimental sites were made at monthly intervals for 1 year. The three patient groups were: top lip (25), axillae (25) and legs (19). Long-term hair reduction was achieved in all patients. A single treatment reduced hair counts by up to 75. Three treatments had an impact for 2 additional months, but not long term. Unexpected spontaneous hair reduction was found 5 months following treatment and lasted 2 months. This ruby laser produced a persistent two-thirds reduction in hair count over 8 months of follow-up. Extension of the follow-up to 12 months did not show significant regrowth. Existing experimental data, together with the results of this study, suggest that hair shaft damage is the key feature in achieving damage to the hair-producing mechanism. The correlation of treatment success and anagen growth phase is less likely.

A review of emergency equipment carried and procedures performed by UK front line paramedics.

OBJECTIVES: To assess which items of resuscitation equipment are carried on United Kingdom (UK) front line ambulances and what procedures paramedics are able to perform. To compare these findings with those of a previous survey in 1997. METHOD: Postal survey to the chief executives of all the UK ambulance services and direct comparison with the data from 1997. RESULTS: Nasopharyngeal airway usage (NPA) has increased (21-55%) and the laryngeal mask airway (LMA) (from 10 to 26%). No services employ the Combitube. 94% of services use a Hudson type trauma mask (increase of 17%). One service no longer allows its paramedics to deliver 12-15 l of oxygen. 68% of trust paramedics can perform needle thoracocentesis (increase of 35%). No paramedics perform chest drain insertion. All services have 14G intravenous cannulae available and 45% carry the intraosseous needle (increase of 30%). No services employ the MAST suit. There is an increase by 29% in the use of crystalloids and a decrease in the use of colloids of 22%. 23% of fluid resuscitation protocols are based upon the principles of hypotensive resuscitation. Spinal boards and extrication devices are used by 97% of services. The use of inflatable splints has decreased (38-23%). There has been a minor increase in the use of traction splints to 74% of services. The use of Entonox is universal. Nalbuphine (Nubain) is the most widely used opioid. The use of morphine/diamorphine has doubled to 10% with a further 26% to introduce their use. 29% of services have equipped some vehicles with automatic external defibrillators. CONCLUSIONS: The equipment available to UK paramedics and procedures that they may perform continues to expand. There are still variations in the basic management of airway, breathing and circulation care and only some services are keeping up to date with current medical thinking, for example the increasing use of crystalloids and hypotensive resuscitation. It remains to be seen whether the widespread use of Nalbuphine as a first line analgesic may decrease as the use of natural strong opiates becomes more widespread.

The UK emergency department practice for spinal board unloading. Is there conformity?

INTRODUCTION: Guidelines for the management of suspected spinal injury patients from the scene of their accident to the emergency department were published in September 1998. This study was commissioned on behalf of the Faculty of Pre-hospital Care at the Royal College of Surgeons of Edinburgh, to examine the handling of patients on spinal boards on arrival in the emergency department. METHOD: In July 2000, 132 postal questionnaires were sent to the consultants of the emergency departments in the United Kingdom (UK) that receive more than 50000 patients per annum. Four simple questions related to spinal board handling were asked. RESULTS: A response rate of 63.6% was achieved and analysis showed that log roll was the technique most commonly used to remove the patient from the board in 90% of cases. In 76.3% of departments this occurred as part of secondary survey although in which part of the secondary survey that this took place was less clear. CONCLUSIONS: It is suggested that as the spine board is such a widely used piece of equipment, there should be some guidelines to standardise its use at the emergency department interface with pre-hospital care. We recommend that spinal board removal should be part of the completion of the primary survey.

Pulsed dye laser treatment of burn scars. Alleviation or irritation?

INTRODUCTION: Burn scars are very common in both children and adults, causing great morbidity and often pose a difficult management problem. This study investigated the efficacy of the dye laser in patients with symptomatic burn scars and analysed the impact of the laser treatment on scar redness, surface texture and pruritus. METHODS: Patients were placed into four groups-adult new scar (n=8), adult old scar (n=10), children new scar (n=5) and children old scar (n=15). The area of scar was divided randomly into treatment and control. Photography, histology, surface textural analysis, Vancouver and pruritus scores were made. Each selected area received three laser treatments at monthly intervals (wavelength of 585 nm with a 5 mm diameter spot at 5-6J/cm(2)). Further assessments were made at 6 and 12 months. RESULTS: Pruritus improved significantly between treatment and control areas (P<0.001). Vancouver scores improved in all groups and sites (P<0.001), but not significantly between treatment and control at 6 (P=0.876) or 12 months (P=0.680). There was no statistical difference between treatment and control in photographic assessment at 6 (P=0.006) or 12 months (P=0.329) and surface profile measurements at 0 (P=0.552), 6 (P=0.107) or 12 months (P=0.227). One patient withdrew from the study because of scar breakdown and three patients were lost to complete follow-up. CONCLUSION: The 585 nm flashlamp-pumped pulsed dye laser is an effective treatment for the intense pruritus often experienced during the healing process after a burn injury. This study has not shown other benefits, such as reduction in scar redness, height and textural improvement to be statistically significant. There is evidence that blood vessel diameters in hypertrophic scar tissue are much smaller than the vessels in port wine stains for which this laser was designed to treat. Therefore, by decreasing the pulse width, more vascular specific damage in the scar may be possible. It is likely that the beneficial effects demonstrated thus far result from changes to the chemical signals that regulate the scar growth and symptoms.

Pre-hospital care--the evolution of a course for undergraduates.

Newly qualified doctors are ill equipped to deal with pre-hospital trauma emergencies. There is a public perception that medical education provides both experience and knowledge in this field. In Birmingham, United Kingdom (UK), committed doctors and nurses trained in pre-hospital care have evolved a specific course designed to equip the medical undergraduate to deal with pre-hospital trauma scenario. The pre-hospital trauma course for medical students has run annually from 1993 to 2000. The course caters for 200 students with a faculty of 30 instructors. Successful completion of the course which is rigorously assessed grants a certificate awarded by the Faculty of Pre-hospital Care at the Royal College of Surgeons of Edinburgh. Most importantly it equips the undergraduate with essential theoretical knowledge and practical skills to handle a pre-hospital trauma emergency.

Chromic acid burns: early aggressive excision is the best method to prevent systemic toxicity.

Chromium poisoning can occur from the cutaneous absorption of chromium from burns that are as small as 1% of the total body surface area. In this case report, we describe a patient with 10% total body surface area burns caused by hot chromic acid. The amount of chromium removed by peritoneal dialysis and the amount of chromium in the urine were estimated, as well as the chromium content in the excised skin, serum, and red blood cells. The extent of chromium load from this type of injury and subsequent risk of systemic poisoning is not predictable, and we therefore believe that systemic toxicity is best prevented by early excision of the burned skin.

Randomized trial of hydroxyethyl starch versus gelatine for trauma resuscitation.

BACKGROUND: Previous studies have demonstrated the rapid increase in systemic capillary permeability after blunt trauma and its association with poor outcome. There are theoretical advantages in resuscitation with colloid fluids, which are well retained in the vascular compartment during times of capillary leak. The aim of this study was to compare the effects of posttrauma resuscitation with hydroxyethyl starch (HES) (molecular mass, 250 kDa) or gelatine (molecular mass, 30 kDa), the hypothesis being that HES would reduce capillary leak. METHODS: Forty-five patients suffering blunt trauma were randomized on admission to receive either gelatine (Gelofusine) (n = 21) or HES (Pentaspan) (n = 24) for the first 24 hours, after which the choice of fluid was at the discretion of the clinician. The mean Injury Severity Score for the HES and gelatine groups were 20.0 (range, 9-41) and 18.1 (range, 9-32), respectively (p = 0.43). Capillary permeability was assessed by urine albumin excretion rate for the first 24 hours. For 5 days the daily mean P(O2)/F(IO2) ratio, serum C-reactive protein, hemoglobin, white cell and platelet counts, prothrombin, and activated partial thromboplastin time were recorded. RESULTS: Capillary permeability was lower in HES-treated patients during the first 24 hours. Log mean (95% confidence interval) albumin excretion rate for gelatine and HES groups at 6 hours were 117.5 (84.9) and 46.8 (24.3) microg/min (p = 0.011), at 12 hours were 54.9 (30.0) and 17.2 (7.6) microg/min (p = 0.001), and at 24 hours were 50.5 (23.4) and 23.6 (16.3) microg/min (p = 0.030), respectively. The mean (95% confidence interval) P(O2)/F(IO2) ratio for the HES and gelatine groups 48 hours after admission were 324 (44) and 267 (43) mm Hg, respectively (p = 0.03). The mean (95% confidence interval) serum C-reactive protein in the HES and gelatine groups 24 hours after admission were 72.4 (19.2) and 105.7 (30.1) mg/L, respectively (p = 0.03). There were no significant differences in any of the hematologic parameters during the first 48 hours. CONCLUSION: The results suggest that compared with gelatine, resuscitation with HES reduces posttrauma capillary leak.

Burn management in a patient with autism.

The successful use of elective post-operative sedation and ventilation following tangential surgical excision of burns in an autistic child. non-compliant with conventional management is reported. Other strategies for treating autistic children are discussed.