Tuberculous dactylitis in the setting of low serum vitamin D: a case report.

We present the case of a previously well patient who presented to the Emergency Department of a Dublin hospital with a tuberculous infection of his dominant index finger and a very low serum vitamin D level--this has been implicated in both primary and reactivation infections with Mycobacterium Tuberculosis. This case highlights and reviews both the importance of considering non-endemic pathologies in the setting of a patient base of diverse ethnicity, and the emerging importance of vitamin D in the immune response to M. tuberculosis infection. We discuss the relevant literature to highlight the background of this disease process, and the importance of a multidisciplinary approach to these patients.

Tag rugby: a safe alternative? A review of hand injuries sustained playing tag rugby (2007 season).

INTRODUCTION: Tag rugby is a non-contact, seven-a-side, team sport in which each player wears specially designed shorts with velcro 'tags' attached to them. While tag rugby is a relatively new sport it has grown rapidly in popularity. As a result of its increasing popularity an increased frequency of attendances at plastic surgery clinics was observed and it was decided a review of all hand injuries associated with this new sport was required. MATERIALS AND METHODS: A retrospective case note review of all hand injuries occurring during the tag rugby season for 2007 (March-August) was conducted, with any tag rugby-related hand injuries being selected for further examination. RESULTS: Tag rugby, while being a non-contact sport, is certainly not without a definite injury risk with 12 patients having single digit injuries, ranging from tendon avulsions to phalangeal fractures. The mean age of the injured patients was 26.8 years. DISCUSSION: All of the hand injuries were sustained while 'tackling' during regular play, the hand injuries sustained were all treated using well-described methods and all the patients are recovering well. While the risk of a severe, life-threatening injury is unlikely while playing tag rugby, there is a real risk of sustaining a potentially debilitating hand injury.

The use of lasers in the treatment of cutaneous lesions.

INTRODUCTION: Laser has progressed significantly over the last three decades. Light amplification by stimulated emission of radiation (lasers) are currently employed by a number of medical and surgical specialties and used to treat a wide range of conditions. AIM: This article aims to provide an insight into laser science and describe its current usage in the treatment of cutaneous lesions and its potential for future developments. CONCLUSION: There are many types of lasers, each having unique properties that enable them to fulfil their task and achieve the desired result. Their applications will no doubt continue to expand with the parallel advancement in laser technology.

Intraoral flap depilation using the long-pulsed alexandrite laser.

A multitude of skin flaps are used to reconstruct defects following the surgical resection of head and neck cancers. Skin imported from distant sites to provide intraoral coverage often contains hair-bearing skin, which can create a problem following reconstruction of the oropharynx. Patients with hairy intraoral flaps often present with irritation, pooling of saliva and trapping of food. In this article, we report, for the first time, a treatment for the removal of hair from intraoral flaps using a long-pulsed alexandrite laser.

Laser depilation and hygiene: preventing recurrent pilonidal sinus disease.

BACKGROUND: Pilonidal sinus disease of the natal cleft is a painful and debilitating condition which often recurs despite multiple surgical undertakings. We describe the long pulsed alexandrite laser for hair depilation and the role of personal hygiene, which is often overlooked when treating this disease, as an adjunct to preventing recurrent pilonidal sinus disease. METHODS: A review of 14 patients who underwent laser hair depilation in the natal cleft following pilonidal sinus surgery. The majority of patients had recurrent disease and had undergone numerous surgical procedures (range 1-5, mean 2.07) All patients were given advice regarding meticulous personal hygiene at the time of consultation. RESULTS: 12 patients received the full course of treatment (three treatments, 6-weekly) followed by 'top-up' treatments as required (mean number of treatments 3.9). None of the patients developed recurrent disease at 1-year follow up and, to date, none have required further surgery. CONCLUSION: Laser hair depilation is a useful adjunct in preventing the recurrence of pilonidal sinus disease and should be offered routinely to all patients. This coupled with patient education regarding personal hygiene reduces the risk of developing recurrent pilonidal sinus disease.

A qualitative study to assess the effectiveness of laser epilation using a quality-of-life scoring system.

BACKGROUND: Facial hirsutism has a negative effect on the quality of life (QOL) of female patients. AIM: To assess the efficacy of laser epilation on the quality of life in hirsute women. METHODS: Over a 6-month period, we recruited 38 patients with severe pathological facial hirsutism. Each patient completed a pretreatment questionnaire consisting of a modified Dermatology Life Quality Index (DLQI), a visual analogue scoring system, and an 'out-of-10' scoring system. The patients were also scored independently by a doctor and a nurse. Each patient received a laser-epilation treatment programme and was reassessed in an identical fashion. RESULTS: Following laser epilation, the mean patient DLQI score fell by 5 points. All three scoring groups scored lower across all scoring methods following laser treatment. There was also correlation in scoring between disciplines. CONCLUSION: DLQI provides a valid scoring system to assess the efficacy of laser epilation. The interdisciplinary scores in this study indicate that an objective grading system for facial hirsutism could be developed in the future.

Thromboembolic prophylaxis in plastic surgery a 12-year follow up in the UK.

Potentially fatal thromboembolic events prevail post-operatively despite the widespread availability of proven methods of prophylaxis. In 1992 Dujon et al published an article which reviewed thromboembolic prophylaxis methods of Consultant Plastic Surgeons in the UK and Ireland. Our follow up study surveyed all current Consultant B.A.P.S members using a modified postal questionnaire to assess practice nationwide. Our conclusions were drawn from comparisons made between the two populations some twelve years apart. Our results show a dramatic change from the previous findings. Since 1992 86% of respondents have developed a set prophylaxis protocol (compared to 19%). The use of low molecular weight heparin has drastically increased by 24% to 76%, the use of flow-tron boots (or similar) has increased by 22% to 68%, the use of TED stockings has increased by 12% to 83%, the use of multi-modality prophylaxis has increased by 27% to 79% Our results demonstrate a definite shift towards multi-modal thromboembolic prophylaxis, possibly due to increased awareness of available technologies and subsequent reduction in costs.