The use of skull X-rays in the accident and emergency department.

The notes of all patients attending the accident and emergency department at the Royal Berkshire Hospital with a head injury from 1-30 September 1999 were analysed for the indications for skull X-ray, the report on film, and the outcome of the consultation. Using the existing Royal Berkshire Hospital guidelines, 50% (193/385) of all patients had skull X-rays performed. One fracture was detected. If the recent guidelines from The Royal College of Surgeons of England Working Party for the use of skull X-rays in institutions which possess a CT scanner were applied, the number of skull X-rays performed would reduce from 193 to 14 without detriment to any patient.

Subluxation of the hip joint in multiple hereditary osteochondromatosis: report of two cases.

We report two cases of children with multiple hereditary osteochondromatosis (MHO) in whom painful restriction of hip movement developed due to intraacetabular osteochondromata. Excision of the lesions relieved pain and restored joint movement after 14 and 3 months' follow-up, respectively. Long-term follow-up of these patients is essential.

Bilateral trigger thumbs in identical twins.

Bilateral trigger thumbs in 4-year-old identical male twins are reported. To the authors' best knowledge, this is the first true description of this condition in identical twins. All four thumbs were treated by surgical release of the A1 pulley, with good results. The causes proposed for congenital and acquired trigger thumb are discussed, and it is concluded that the cases described here support a genetic predisposition to the condition.

Small bowel function after aortic surgery.

One cause of post-operative morbidity in the elective repair of abdominal aortic aneurysms is the development of a paralytic or 'adynamic' ileus. In a series of 20 consecutive patients undergoing such a procedure, the maintenance of small bowel motility and absorptive capacity in the immediate post-operative period was assessed using barium sulphate and xylose passed down a naso-duodenal tube sited at the time of surgery. This simple study demonstrated that small bowel function was preserved in all cases, and hence that patients could be fed enterally via naso-duodenal tube (in particular using very low residue formulae) rather than using costly parenteral regimens, should an ileus persist.

Self protection in surgery: the use of double gloves.

This study assesses the perforation rate of single and double gloves and thus the extent to which double gloving protects the surgeon from diseases transmissible from the patient. We have also investigated whether double gloving offers the patient extra protection by reducing wound sepsis. Two hundred adult hernia repairs were performed, the first 100 single gloved and the second 100 double gloved. Glove perforation rates were not significantly different between single gloves and the outer of the double gloves. Although 46 of 400 outer gloves were perforated there were only 15 inner glove perforations and only eight of these matched the outer perforations. The percentage of operations in which the latex protective barrier was breached was reduced from 31 per cent when the surgeon wore single gloves to 8 per cent with double gloves. Wound sepsis was not increased by glove perforation nor reduced by double gloving. While careful technique remains mandatory we conclude that double gloving offers increased protection to the surgeon operating on high risk infectious cases.

Surgical glove perforation.

In a study to investigate the incidence and significance of surgical glove perforation, bacterial contamination of surgeons' hands and gloves before and after operation was measured and the gloves tested for damage. Perforations were found in 74 of 582 gloves (12.7 per cent) and occurred in 34.5 per cent of operations. Glove perforation did not influence bacterial counts on the surgeons' hands or on the outside of their gloves. A separate clinical study of 100 adult hernia repairs gave no evidence that perforation increased wound sepsis. After standard pre-operative hand preparation, glove perforations are of no clinical significance to the patient, but their high incidence should alert surgeons to the need for protection against pathogens transmissible during surgery, such as hepatitis B and the human immunodeficiency virus. Protection of the surgeon is the main indication for preoperative change of damaged gloves.