The importance of petrous apex and peri-carotid pneumatisation in subtotal petrosectomy and blind sac closure: a radiological study.

OBJECTIVE: To ascertain in what proportion the vertical segment of the intratemporal carotid artery on its medial aspect anatomically separates the peri-tubal cells and Eustachian tube from the remainder of the pneumatised spaces of the temporal bone. METHOD: A retrospective review was conducted of 222 adult and 29 paediatric consecutive computed tomography scans of petrous temporal bones from a single tertiary referral centre. RESULTS: In 96 per cent of temporal bones, the carotid artery formed a lateral barrier (with no communication pathway medially) between air spaces anterior and posterior to it. This equated to 94 per cent when chronic otitis media cases were excluded. CONCLUSION: The degree of separation of middle-ear air cells from the Eustachian tube or nasopharynx, and the relevant anatomy, are reviewed. This knowledge helps to optimise the outcome of subtotal petrosectomy and blind sac closure. The frequency and process of pneumatisation of the petrous apex, and its connections with the middle ear, have been radiologically confirmed.

Traumatic amputations in children and adolescents: demographics from a regional limb-fitting centre in the United Kingdom.

There is no published literature detailing the demographics of paediatric amputations in the United Kingdom. We performed this review of children and adolescents referred to a regional limb-fitting centre from the 1930s to the current decade who suffered amputation as a result of trauma, and compared our data with similar cohorts from other units. Of the 93 patients included, only 11 were injured in the last 20 years. Road traffic accidents accounted for 63% of traumatic amputations. Of all amputations, 81% were in the lower limb and 19% in the upper limb. Our figures are similar to those from a United Kingdom national statistical database of amputees which showed on average four traumatic amputee referrals to each regional limb-fitting centre in the United Kingdom per ten-year period. Compared with the United States, the incidence of paediatric traumatic amputations in the United Kingdom is low.

An unusual complication of a myoelectric prosthesis.

This clinical note describes an unusual and previously unreported complication of wearing a myoelectric prosthesis in a child with congenital upper limb deficiency. After an initial period of wearing a cosmetic prosthesis, he was provided with a child's trans-radial myoelectric prosthesis with a Steeper Scamp Electric hand at the age of 21 months. After successful and uncomplicated use of this prosthesis for 2 years--a sudden onset of burns of the skin of the stump underlying the single electrode site was noted. The cause of the burns was thought to be due to heat generated from electrical failure possibly from ingress of moisture. This complication has not before been experienced in the authors' centre, nor has it been reported in the literature. While constant improvements are being made in the field of electrically powered prosthesis, the rehabilitation team should be aware of this unusual complication.

Clinical tests for carpal tunnel syndrome: an evaluation.

Five clinical tests in common use for diagnosis of carpal tunnel syndromes have been shown to have little diagnostic value, either individually or in various combinations. No physical sign is useful in the diagnosis of this condition, which should be suspected on the basis of presenting symptoms and confirmed by electrodiagnosis using standard median nerve conduction tests.