Urinary point-of-care test for smoking in the pre-operative assessment of patients undergoing elective plastic surgery.

Self-reported information about smoking habit and cigarette consumption can be inaccurate and subject to bias in the clinical setting. Accurate assessment of a given smoking history at point-of-care is valuable. We describe the use of a comprehensive smoking questionnaire and the use of a disposable biomarker test to verify and quantify the exposure to tobacco smoke. This point-of-care test (SmokeScreen) is a 6-min, easy-to-use urine test that measures nicotine and its breakdown products. One hundred consecutive patients attending plastic surgery pre-assessment clinic filled in the questionnaire and gave a consented urine sample. Qualitative and semi-quantitative assessment of tobacco consumption was observed by a simple sample colour change set against a standardised colorimetric chart for nicotine metabolite containing urine. The questionnaire self-reported smoking prevalence was 30% with 98% test specificity. The cotinine validated smoking prevalence was 54% with a 26% self-denial rate. Half the patients (n = 15) who admitted smoking on the questionnaire underreported the amount they smoked daily, as quantified by biochemical measurement. Objective biochemical assessment shows that 26% of self-reporting non-smokers via self-completed questionnaire studies are actual smokers attending this pre-assessment clinic. When patients did report smoking there was consistent underreporting of cigarette consumption.

Conflicts in the treatment of chronic ulcers in drug addicts--case series and discussion.

Vascular access in intravenous drug abusers may become compromised by the repeated injection of toxic substances. In such circumstances abusers are driven by their addiction to seek alternative routes of drug delivery. We report a series of individuals with chronic ulcers, which were cultivated and maintained for the administration of heroin. We advise that practitioners should be wary of granulation tissue being promoted in this way and suggest that the patients' desire for wound healing may be overridden by their addiction and that successful treatment of these wounds is reliant upon cessation of drug abuse and patient compliance. In our experience this is most easily achieved in a multidisciplinary environment.

Hot-air ballooning injuries in the United Kingdom (January 1976-January 2004).

OBJECTIVES: Injuries due to hot-air ballooning accidents are uncommon but may be severe. In this study we examined the factors contributing to ballooning accidents in the UK and the type of injuries sustained. METHODS: The post-investigation reports of ballooning accidents from 1976 to 2004 were reviewed. They were analysed to determine type and severity of injuries, phase of flight at time of accident and causative or contributory factors. RESULTS: Sixty-one people were seriously injured in 98 ballooning accidents, with 2 fatalities. The majority of these accidents occurred during the approach and landing phase of flight. Ground collisions and crashes with power lines accounted for the majority of accidents. Adverse weather conditions were present in a significant number of crashes. Equipment failure was an uncommon cause of accidents. Fractures and burns were the most common form of injuries sustained. CONCLUSIONS: Changes in design and materials used, as well as adherence to specific recommended safety protocols, may aid to decrease the risk of severe burns in ballooning accidents. We discuss these factors illustrated by our experience of the worst recorded ballooning accident in Britain.

Upper limb splints and the right to drive--who decides?

Management of upper limb pathology frequently requires the wearing of a splint for a period of time. Our Occupational Therapy Department fits approximately 2000 thermoplastic splints per year. A significant number of these patients drive. In a bid to try and elucidate who is thought to have and who actually has responsibility for deciding which splints are safe to drive in we sent photographic questionnaires to patients, general practitioners (GPs), the police and driver and vehicle-licensing agency (DVLA). We performed a telephone survey of insurance companies. It is the duty of the patient to contact the DVLA if they have any doubt about their ability to drive safely whilst wearing the splint. Our results demonstrate only 10% of patients and 4% of GPs are aware of this. There was strong agreement between patients, GPs and the police about which splints would probably be safe to drive in, but patients need to be reviewed on an individual basis. Our study demonstrates a lack of knowledge among patients and GPs which could expose either group to adverse legal action in the event of an accident.

Digital operation notes: a useful addition to the written record.

The use of photographic images to supplement written records has been used in clinical medical practice for many years. The additional information that a photograph provides is useful to record pathological findings, anatomic changes, surgical relationships, and outcomes. Obtaining relevant, good-quality digital images is extremely easy with the new generation of digital camera systems. The images obtained are very versatile and can be either printed as hard copies or stored in image databases. With the advent of electronic patient records, written operation notes can be stored alongside images to give a more complete account of a patient's treatment. Networked computer systems allow access to these records from a variety of different locations, thereby improving the use of photographs by different specialties. The authors encourage intraoperative photography to enhance the written operation note and have found it helpful to fellow surgical colleagues, pathologists, and physiotherapists in overall patient care.

Endoscopic-assisted transaxillary removal of a midline anterior epidermoid cyst.

A 3-year-old boy presented with a 3 x 3 cm dermoid cyst in the midline of the anterior chest wall. This was successfully removed, using an endoscopic-assisted technique, through a single incision placed in the anterior axillary fold, avoiding the need for a mid-sternal incision. This technique and its application to paediatric soft-tissue surgery are discussed.