Anabolic steroid accelerated multicompartment syndrome following trauma.

The case is reported of a 23 year old male body builder who was involved in a road traffic accident after taking anabolic steroids. The resulting trauma caused a severe life threatening acute multicompartment syndrome resulting in the need for urgent multiple fasciotomies.

Lymphoscintigraphy and sentinel lymph node biopsy for melanoma.

The role of the sentinel node in the management of malignant melanoma is currently being investigated in specialist centres the world over. The methods employed in identifying the sentinel node(s) depend on the locally available human and technical resources. We describe a three-part technique commonly used by most established centres i.e. lymphoscintigraphy, vital blue dye injection and the use of intra-operative gamma probe.

Open cholecystectomy: muscle splitting versus muscle dividing incision: a randomized study.

While laparoscopic cholecystectomy has become the standard procedure for symptomatic gallstones, it is likely that 10% of patients will require an open cholecystectomy whether owing to contraindications to the laparoscopic approach or because conversion to the open technique became necessary following laparoscopy. Although the trend towards smaller open cholecystectomy incisions has led to a reduced hospital stay, much of the postoperative morbidity can be ascribed to wound pain. Muscle splitting incisions tend to be less painful than muscle dividing incisions. This randomized consecutive study of elective and emergent open cholecystectomies compared a muscle splitting incision with the traditional muscle dividing technique. The muscle splitting technique was significantly (P < 0.001) less painful than the muscle dividing method as evaluated by the short form of the McGill pain questionnaire. Similarly, a significantly greater proportion of patients were fully mobile on the first and second postoperative day in the muscle splitting group compared with the muscle dividing group. Analgesia requirements, however, were not statistically significant between the two groups. We recommend that when open cholecystectomy is necessary the muscle splitting technique should be employed.

Cardiac anomalies complicating congenital contractural arachnodactyly.

A newborn boy with congenital contractural arachnodactyly (CCA) was found to have an atrial septal defect, ventricular septal defect, patent ductus arteriosus, and aortic arch anomalies. These resulted in congestive failure but subsequent progressive dilatation of both great arteries and development of aortic regurgitation were associated with eventual cardiorespiratory failure and death at 11.5 months. Others have noted that cardiac anomalies in CCA may be comparable with those of infantile Marfan's syndrome. Our case further extends the spectrum of cardiac abnormalities in CCA and substantiates that there is overlap with infantile Marfan's syndrome. This fact and our literature review suggest that early and complete cardiac assessment is necessary for appropriate management and evaluation of prognosis in any newborn infant with findings suggestive of either condition.

Ruptured abdominal aortic aneurysms.

A series of 180 consecutive patients with ruptured aortic aneurysms has been studied to determine the causes of death. 18% died before operation could be carried out, 8% proved inoperable and a further 10.5% died before operation could be completed. Overall mortality was 75%. By multivariate analysis, the most significant preoperative features influencing survival were a systolic BP less than 80 mmHg on admission and a history of hypertension, angina or myocardial infarct. The mortality increased with increasing age. Administration of fresh frozen plasma preoperatively significantly increased survival. However, we could not identify a single group of patients for whom the outcome was inevitably fatal.