Concurrent Transitional Meningioma and Ceruminous Gland Adenocarcinoma in a Scottish Wildcat Hybrid (Felis silvestris).

The Scottish wildcat (Felis silvestris) is an iconic and endangered subpopulation of the European wildcat (F. silvestris silvestris). There is much research devoted to the ecology, genetics and conservation of this animal, but little published information on pathology and disease. The investigation and reporting of such information is vital to furthering understanding of the effects of hybridization, a factor that is crucial if we are to secure a future for the Scottish wildcat. This report describes the clinical presentation, gross post-mortem and histological findings in an elderly Scottish wildcat hybrid with concurrent transitional meningioma and ceruminous gland adenocarcinoma.

A double-blind randomised controlled study comparing subacromial injection of tenoxicam or methylprednisolone in patients with subacromial impingement.

We have carried out a prospective double-blind randomised controlled trial to compare the efficacy of a single subacromial injection of the non-steroidal anti-inflammatory drug, tenoxicam, with a single injection of methylprednisolone in patients with subacromial impingement. A total of 58 patients were randomly allocated into two groups. Group A received 40 mg of methylprednisolone and group B 20 mg of tenoxicam as a subacromial injection along with lignocaine. The Constant-Murley shoulder score was used as the primary outcome measure and the Disability of Arm, Shoulder and Hand (DASH) and the Oxford Shoulder Score (OSS) as secondary measures. Six weeks after injection the improvement in the Constant-Murley score was significantly greater in the methylprednisolone group (p = 0.003) than in the tenoxicam group. The improvement in the DASH score was greater in the steroid group and the difference was statistically significant and consistent two (p < 0.01), four (p < 0.01) and six weeks (p < 0.020) after the injection. The improvement in the OSS was consistently greater in the steroid group than in the tenoxicam group. Although the difference was statistically significant at two (p < 0.001) and four (p = 0.003) weeks after the injection, it was not at six weeks (p = 0.055). Subacromial injection of tenoxicam does not offer an equivalent outcome to subacromial injection of corticosteroid at six weeks. Corticosteroid is significantly better than tenoxicam for improving shoulder function in tendonitis of the rotator cuff after six weeks.

Osteonecrosis of the jaws and bisphosphonate therapy.

Bisphosphonates are a class of agents used to treat osteoporosis and malignant bone metastases. The efficacy of these agents in treating and preventing the significant skeletal complications associated with these conditions has had a major positive impact for patients and is responsible for their widespread use in medicine. Despite these benefits, osteonecrosis of the jaws has recently emerged as a significant complication in a subset of patients receiving these drugs. Based on a growing number of case reports and institutional reviews, bisphosphonate therapy may cause exposed and necrotic bone that is isolated to the jaw. This complication usually presents following simple dento-alveolar surgery, and can cause a significant adverse effect on the quality of life for most patients. The pathogenesis for this complication appears to be related to the profound inhibition of osteoclast function and bone remodeling.

Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires.

This prospective, randomized trial compares the infection rates of Kirschner wires left percutaneously and those buried deep to the skin in a group of patients with isolated distal radial fractures. Percutaneous wires had a significantly greater infection rate than wires which were buried deep to the skin.

Phalangeal metastasis secondary to an occult breast carcinoma.

We report a case of a silent, highly malignant tumour of the breast, which presented as an atraumatic deformity of the finger secondary to a phalangeal metastasis.

Distraction osteogenesis.

Distraction osteogenesis is a surgical technique originally used to lengthen the long bones without bone grafting. An osteotomy is created and by slowly separating the two segments with specially fabricated hardware, the biological distractant will grow with the bone and calcify into mature bone once the appropriate length has been achieved. Distraction techniques have been used in the human facial bone area for the past 10 years. This article reviews the basic uses of distraction osteogenesis, the pros and cons, and possible future techniques.

The oral and maxillofacial surgeon's role in the care of patients with cleft lip and palate deformities.

Perhaps no conditions other than cleft lip and palate and oral cancer assemble teams of dentists and physicians intensely focused on treatment and rehabilitation. The oral and maxillofacial surgeon's role is often pivotal especially in the 20-year term of care for the child born with a cleft lip and palate deformity (CLPD). Issues of basic orofacial functions of mastication, respiration and communication overlay human considerations of self-esteem and image. From the moment of birth the child with a CLPD is special and challenged. Early issues concern parent and family acceptance and insuring basic life functions. While not generally a part of the immediate surgical unit, the OMFS often provides surgical consultation, educational and emotional support for the family. A clear picture must be painted of the treatment that will unfold over the next two decades. Realistic optimism is the watchword. Indeed, today there is every reason to anticipate an outcome that will result in a balanced, functional and esthetic face.

The use of facsimiles in acute patient transfers: experience with brachial plexus injuries.

In order to optimize the transfer of patients with acute brachial plexus injuries a facsimile proforma was introduced. The transfer of 20 patients prior to its introduction was compared as a retrospective control group with a prospective analysis of 20 patients transferred after the introduction of the facsimiles. There were many fewer missed injuries, the patients were better investigated and it as easier to decide when to delay patient transfer. Subjectively there was a considerably easier passage of both medical and social information about the patients. The cost of the facsimile and its use is more than compensated by the savings in reduced impatient stay, the reduced need for urgent tests upon receipt of the patient, fewer phone calls and considerably reduced administrative workload.

Re-innervation of facial nerve territory using a composite hypoglossal nerve--muscle autograft--facial nerve bridge. An experimental model in sheep.

The hypoglossal nerve has been used both entirely and in part to repair the facial nerve. Using the partial technique it may be difficult to obtain sufficient length and a free interposed graft is then required to extend the hypoglossal element. In six sheep the facial nerve was excised between its emergence from the stylomastoid foramen and its bifurcation in the parotid gland. The hypoglossal nerve was exposed and split longitudinally producing a limb which was reflected towards the distal stump of the facial nerve. This left a gap of 4-5 cm which was bridged with a freeze-thawed coaxially aligned skeletal muscle autograft. The sheep were examined at 8 months. Laser doppler blood-flow studies showed the blood-flow distal to the graft to be about 25% of that at an equivalent site on the normal side. Peak nerve conduction velocities were also reduced on the repaired side but stimulation of the proximal hypoglossal nerve was nevertheless capable of causing adequate contraction of both facial and tongue muscles. Histological comparison of the repaired facial nerves with equivalent sites on the normal side showed a reduction in mean axon and fibre diameters with normal myelin sheath thickness for the regenerated axon sizes. All of these features are to be expected in a regenerated nerve and are consistent with a good level of recovery of function.

A slowly evolving brachial plexus injury following a proximal humeral fracture in a child.

The association of fractures and neurological injuries is well recognized, especially with certain upper limb fractures. Typically, the nerve injury occurs at the time of initial fracture displacement. A case is reported of an unusual combination of fracture and nerve injury in a child, with the extremely rare occurrence of a slowly evolving nerve injury. The potential for delayed nerve injury following a fracture needs to be appreciated to prevent delays in diagnosis and treatment.

Repair of the facial nerve in the cerebellopontine angle using freeze-thawed skeletal muscle autografts. An experimental surgical study in the sheep.

Six adult blackface sheep underwent repair of the transected facial nerve in the cerebellopontine angle using short freeze-thawed muscle autografts. A typical facial palsy was observed on the side of the intervention immediately after operation. The sheep were allowed to recover for one year by which time clinical observation showed a complete recovery of the facial palsy in 5 sheep and a partial recovery in the remaining sheep. Under general anaesthesia function of the repaired VIIth nerve and the normal contralateral facial nerve were assessed using electrophysiological stimulating and recording techniques. These studies showed restoration of facial nerve continuity to have taken place with functional reinnervation of target facial muscles. Electrophysiological indices of nerve function were consistent with those expected after repair of any peripheral nerve. Morphometric study of the nerves after their removal showed structural changes which though quantitatively different from those of normal nerve were consistent with those seen in other sites and studies where nerves have been repaired. This technique is discussed as a possible treatment for facial nerves whose continuity is disrupted during the removal of cerebellopontine angle tumours.

Metoclopramide as prophylaxis for nausea and vomiting induced by fluorescein.

Fluorescein angiography carries with it a variable incidence of nausea and vomiting. We investigated a method of prophylaxis against this side effect. One hundred patients undergoing fluorescein angiography were pretreated in a double-masked, randomized fashion with either 20 mg of intravenous metoclopramide hydrochloride or an equal volume of normal saline solution. The metoclopramide-treated group demonstrated a statistically significant decrease in the incidence of nausea and vomiting. Eleven (22%) of the control group and three (6%) of the metoclopramide-treated group had this complication. Metoclopramide is an effective drug when used prophylactically in selected patients undergoing fluorescein angiography.