A national survey of instrument sharpening guidelines.

Most orthopaedic procedures involve high-speed tools, which can cause thermal necrosis of bone. Blunt instruments are likely to generate more heat, thereby increasing the chances of thermal necrosis. This could greatly compromise the outcome of even the best prosthesis in good surgical hands. In today's age a lot of emphasis is laid on high performance and longevity of the implant. Therefore, it is worthwhile that we consider the relevance and importance of instrument sharpening. We carried out a survey across hospitals in UK to find out whether they follow any guidelines or protocol with regards to instrument sharpening. Upto 75% of hospitals did not follow any guideline or policy, while 20% of hospitals carried out some sort of quality checks on instruments. This implies that there could be a significant risk of suboptimal outcome due to unnecessary osteonecrosis that can affect most operative orthopaedic interventions, particularly joint arthroplasties. Blunt instruments are too common in orthopaedic theatres and this problem needs to be addressed. Our study brings to light the fact that there seems to be no consensus on this issue and there is theoretically a significant risk of suboptimal outcome because of unnecessary osteonecrosis. This potentially may affect the long and short-term results even in good hands and with excellent prosthesis (cemented or uncemented).

Sexual dysfunction after therapy for cervical carcinoma.

PIP: Until the Kinsey report there had been very little published concerning sexual activity in the aging woman. Since then other authors have stated that chronic illness or lack of a sexual partner rather than age have placed limitations on their sexual activity. This study reports the effect of different modes of therapy for invasive carcinoma of the cervix on subsequent sexual function, and also tries to establish a correlation with the type of changes of the vaginal anatomy. Radiotherapy alone had been performed on 28 patients, surgery alone on 32, and combined treatment on 15. All were clinically free of cancer for 1 year after treatment was completed. The youngest was aged 23 and the oldest 68. Of the 28 patients treated with radiotherapy alone 22 had developed shortening or narrowing of the vagina sufficient to interfere markedly with sexual function. Only 2 of the 32 surgically treated patients had such a sexual interference. With combined treatment 60% showed some vaginal alterations and 33% sexual dysfunction. Questioning of patients revealed the importance of sexual function in the lives of middle-aged women. Therefore preference is expressed for radical surgery in the treatment of early carcinoma of the cervix because this mode of therapy interfers minimally with the sexual function.^ieng