ABSTRACT
A randomly selected, age-stratified sample of subjects 50 years of age and older, living in the Salford Health District area of Greater Manchester was drawn from the age-sex register of a four-doctor group practice and invited by post to enter a study of ptosis. Of 851 subjects approached, 499 (59%) replied. Of these, 99 refused to participate. The remaining 400 were visited at home and underwent a standardized protocol of ophthalmic history, and examination including a photograph of the eyes in the primary position. Forty-six (11.5%) of the subjects had ptosis and its prevalence increased with age. Ptosis was bilateral in 18 (39%) and unilateral in 28 (61%). In all but four cases, the ptosis was acquired. The cause was evident in 23 (50%), with 11 cases being due to mechanical ptosis and 12 to aponeurotic disinsertion secondary to a known pathology. A further 22 cases had primary aponeurotic disinsertion and there was one case of probable myasthenia gravis. The prevalence of pupillary diameter of 1 mm or less increased significantly with age.
Subject(s)
Blepharoptosis/epidemiology , Geriatric Assessment , Population Surveillance , Reflex, Pupillary , Aged , Aged, 80 and over , Blepharoptosis/etiology , Cross-Sectional Studies , England/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Refractive Errors/epidemiology , Refractive Errors/etiology , Sampling StudiesABSTRACT
One of the most frequent causes of epidermal inclusion cysts is trauma involving the epidermis with subsequent implantation of epidermal cells into the dermis or subcutis. Minimal incision surgery is capable of achieving this because it is performed by using small incisions and rapidly rotating power instruments. The technique requires that the surgeon master a high degree of dexterity and knowledge of the anatomy without the aid of direct visualization. Van Enoo and Cane suggest the use of fresh, sharp skin blades to protect against invagination of skin edges which could lead to epidermal inclusion cysts. They also state that an improper position or an incision that is too small will cause tension, which can lead to heat buildup with subsequent sloughing and dehiscence. It may also drive some epidermal cells underneath the dermis and foster an epidermal cyst. Other surgeons using small incisions suggest thorough and copious irrigation to flush away debris and to avoid potential foreign body reactions. The periosteum should be reflected away from the point where the drill bit exits the bone to prevent bone chips from being forced subperiosteally and potentially causing a foreign body reaction. By virtue of the technique, minimal incision surgery lends itself to a greater risk of causing epidermal inclusion cysts. Surgeons who use these techniques must be aware of this potential complication.
Subject(s)
Epidermal Cyst/etiology , Foot Diseases/etiology , Postoperative Complications , Adult , Epidermal Cyst/pathology , Epidermal Cyst/surgery , Female , Foot Diseases/pathology , Foot Diseases/surgery , Humans , Postoperative Complications/surgery , Toes/pathology , Toes/surgeryABSTRACT
Review of the anatomy contributing to calcaneal spur formation is provided. Freshly amputated limbs, used because they are not subject to the effects of the preservatives that effect cadaveric limbs, are the basis for the study the authors report. An alternative theory to the cause of heel spurs is presented based on that study.
Subject(s)
Calcaneus , Exostoses/etiology , Exostoses/physiopathology , Foot/physiology , Muscles/physiology , Biomechanical Phenomena , Calcaneus/anatomy & histology , Calcaneus/pathology , Calcaneus/physiopathology , Heel , HumansABSTRACT
This study shows that equinus has a definite impact on predisposing a child to Sever's disease. The clinician may still need to rule out other possible causes of this condition, but equinus is a probable cause and must be treated appropriately.
Subject(s)
Calcaneus , Epiphyses , Equinus Deformity/complications , Osteochondritis/etiology , Adolescent , Child , Female , Humans , Male , Osteochondritis/complicationsABSTRACT
An audit of 150 consecutive cases of abdominal pain presenting to an urban teaching practice between October 1983 and May 1984 was performed. The median duration of pain prior to presentation was two days. Females predominated in all age groups.Eighty-nine per cent of these patients were managed entirely in the practice and of these, 52 per cent were managed with reassurance and advice alone, while 48 per cent also received a prescription. Only 15 per cent of patients were investigated in any way by the practice. Of the 17 patients (11 per cent) referred, nine were referred as emergencies and eight were admitted that day. However, there were only three true surgical emergencies in the entire series (one appendicitis, one intussusception and one fulminating pancreatitis).
