Modified Scharli technique for the very long gap esophageal atresia.

This modification of the Scharli technique which creates an isoperistaltic tube to overcome very long gap esophageal atresia involves retention of the short distal esophageal segment and creation of a neo-esophagus of tubularized gastric fundus of even calibre, similar to that of the upper esophageal segment. It has proved simple and effective in establishing esophageal continuity.

Burn injury care for Special Forces and far-forward deployed troops.

Special Forces are at risk of serious burn injury. We have suggested standard operating procedures for burn injury management in a constrained environment, with novel uses of operational kit components for trauma care. In addition, we propose instruction in basic skills of escharotomy for forward troops.

Congenital trismus secondary to masseteric fibrous bands: a 7-year follow-up report as an approach to management.

A 7-year prospective follow-up report, which was previously presented in this journal as an initial pediatric case report, is presented as an approach to management of congenital trismus secondary to masseteric fibrous bands. Adams and Rees discussed management, including endoscopic exploration at 18 months of age with early recurrence of trismus. Under the care of the same plastic surgeon and his team, the progress of this patient over 7 years has given us an insight into management. The cause of trismus is not fully elucidated, but the condition can result in compromised caloric intake, speech development, facial appearance, dental care, and oral hygiene. The decreased oral opening may be secondary to shortening of the muscles of mastication, which may cause tension moulding and distortion of the coronoid process; yet, there is no consensus on the optimal management of temporomandibular joint trismus and all its causes. The patient presented in this report, now aged 7 years, has proceeded through to open surgery on two occasions yet, regrettably, has persistently tight masseter muscles and only 8 mm of jaw opening.

Reduced hospitalisation of burns patients following a multi-media campaign that increased adequacy of first aid treatment.

CONTEXT: Concern engendered by a previous study that showed inadequate first aid for burn injuries was prevalent in the community led to a novel multi-media public health campaign ensued to address the issue. OBJECTIVE: To determine whether this public health campaign influenced behaviour by altering first aid treatment for burn injuries (BFAT). DESIGN, SETTING AND POPULATION: Prospective intervention study. Consecutive patients with acute burn injuries over two 4-month intervals, presenting to a regional burn service, Auckland, New Zealand. This research was ethically approved by the Local Research Ethics Committee. MAIN OUTCOME MEASURES: Demographics, burn size, adequacy of burn first aid, outpatient/inpatient wound care and operative intervention requirement. RESULTS: Adequacy of BFAT improved following the campaign (59% versus 40%, P=0.004). Fewer inpatient admissions (64.4% versus 35.8%, P<0.001) and surgical procedures (25.6% versus 11.4%, P<0.001) were undertaken following the campaign with a corresponding increase in outpatient care. Greatest decreases were observed in Maori and Pacific Islanders, and in children <10 years old. CONCLUSIONS: Adequacy of BFAT together with a reduction in the numbers of patients requiring inpatient surgical care was improved by a multi-media public awareness campaign.