Inferior angle of scapula fractures: a review of literature and evidence-based treatment guidelines.

BACKGROUND: Inferior angle of scapula (IAS) fractures are rare, with very few cases reported. They typically present with pain, loss of shoulder motion, and scapula winging. Operative and nonoperative treatments have been trialed with varying success. The aim of this study was to gather data relating to IAS fractures to develop evidence-based treatment guidelines as none are currently available. METHODS: A search was conducted of the PubMed and Google Scholar databases to identify cases of IAS fractures. Data collected about each case included age and gender of the patient, mechanism of injury, fracture displacement, treatment, and outcome. The authors report 2 additional IAS fracture cases. RESULTS: Ten cases were identified for inclusion in this study, 8 from the literature and 2 described by the authors. Of the 10 cases, 7 described displaced IAS fractures and 3 described undisplaced fractures. All displaced fractures treated nonoperatively resulted in a painful nonunion. All that underwent operative fixation, whether acutely or after failed nonoperative treatment, had resolution of pain and a good functional outcome. All undisplaced fractures were treated nonoperatively; 1 had persisting pain. Surgical exploration identified the fracture fragment attached to serratus anterior in 2 cases and attached to both serratus anterior and latissimus dorsi in 2 cases. DISCUSSION AND CONCLUSIONS: There are limited data available about IAS factures. From the cases reviewed, treatment recommendations include the following: (1) displaced IAS fractures should undergo operative fixation to prevent the development of a painful nonunion; (2) suture repair provides adequate fixation; and (3) undisplaced fractures have a variable outcome when treated nonoperatively.

Differing Serum Cea in Primary and Recurrent Rectal Cancer - A Reflection of Histology?

BACKGROUND: Serum carcinoembryonic antigen (CEA) levels are not universally measured in colorectal cancers. CEA levels have been reported to be usually normal at time of primary rectal cancer diagnosis but elevated in recurrent disease. The aims of the study were to (1) compare serum CEA levels performed at time of primary and recurrent colorectal tumour diagnosis; and (2) to determine serum CEA levels in rectal cancers at primary diagnosis to analyse potential factors influencing differing CEA levels. METHODS: A retrospective analysis of patients treated for colorectal cancers at Modbury Hospital, South Australia was performed. Each admission was reviewed within the electronic database. Serum CEA levels and tumour-related factors were determined in patients who underwent curative surgery for their primary tumour and developed tumour recurrence/metastases within the study period. RESULTS: 438 patients were treated for colorectal cancer in the study period. In patients who underwent curative surgery and developed a recurrence, serum CEA was elevated in 20% patients at primary diagnosis and in 46.6% patients at recurrence. Only 1 of 30 patients with rectal cancer had an elevated CEA at diagnosis of primary tumour. Tumour relationship to the peritoneal reflection did not appear to play a role. CONCLUSIONS: In rectal cancers, serum CEA levels are often normal at the time of initial diagnosis. However, this should not preclude its use in post-operative surveillance. Serum CEA levels noted in primary rectal cancer appear unrelated to the relationship of the tumour to the peritoneal reflection. Stroma-related factors could possibly be involved and merit further investigation.

Depilatory wax burns: experience and investigation.

OBJECTIVES: To retrospectively collect data on patients with burn injury due to hot depilatory wax. To investigate the effect of varying microwave output power on wax temperature. To determine whether instructions provided by manufacturers allow safe domestic use. METHODS: Data from the RAH burns database was collected for patients with wax-induced burns between January 1991 and January 2010. Wax temperatures were tested in a pilot study (4 wax products heated in microwave with power outputs of 800 W, 900 W, and 1100 (W) and a definitive study (5 wax products, 3 of each, heated in microwave with power outputs of 800 W, 1000 W, and 1200 (W). A number of different heating regimens were employed and temperatures were recorded using an infrared thermometer. RESULTS: Twenty-one patients were studied. Mean age was 26.5 years. The majority of burns were superficial (33.3%) or partial thickness (25.8%). The right hand was most commonly affected (38.1%), the mean total body surface area was 1%. The pilot study revealed an increase in wax temperature with the number of times the wax was heated. During definitive wax temperature testing, the maximum wax temperature recorded was 108.5°C. Seventeen of 60 wax surface temperatures recorded exceeded 90°C, 9 exceeded 100°C. Ninety-three percent of the stirred wax temperatures showed an increase in wax temperature with an increase in microwave power output. CONCLUSION: Microwave-heated hair-removal wax has the potential to reach unsafe temperatures and cause burn injury, even when manufacture's heating instructions are followed. Safe use in domestic setting requires improvements in instructions provided by the manufacturer.