Comparison of dynamic magnetic resonance defaecography with rectal contrast and conventional defaecography for posterior pelvic floor compartment prolapse.

AIM: This study compared the diagnostic capabilities of dynamic magnetic resonance defaecography (D-MRI) with conventional defaecography (CD, reference standard) in patients with symptoms of prolapse of the posterior compartment of the pelvic floor. METHOD: Forty-five consecutive patients underwent CD and D-MRI. Outcome measures were the presence or absence of rectocele, enterocele, intussusception, rectal prolapse and the descent of the anorectal junction on straining, measured in millimetres. Cohen's Kappa, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the positive and negative likelihood ratio of D-MRI were compared with CD. Cohen's Kappa and Pearson's correlation coefficient were calculated and regression analysis was performed to determine inter-observer agreement. RESULTS: Forty-one patients were available for analysis. D-MRI underreported rectocele formation with a difference in prevalence (CD 77.8% vs D-MRI 55.6%), mean protrusion (26.4 vs 22.7 mm, P = 0.039) and 11 false negative results, giving a low sensitivity of 0.62 and a NPV of 0.31. For the diagnosis of enterocele, D-MRI was inferior to CD, with five false negative results, giving a low sensitivity of 0.17 and high specificity (1.0) and PPV (1.0). Nine false positive intussusceptions were seen on D-MRI with only two missed. CONCLUSION: The accuracy of D-MRI for diagnosing rectocele and enterocele is less than that of CD. D-MRI, however, appears superior to CD in identifying intussusception. D-MRI and CD are complementary imaging techniques in the evaluation of patients with symptoms of prolapse of the posterior compartment.

A randomised controlled trial of a double layer of Allevyn compared to Jellonet and proflavin as a tie-over dressing for small skin grafts.

INTRODUCTION: The tie-over dressing is used to encourage skin graft take by minimising dead space, reducing seroma and haematoma formation and by graft immobilisation. Various materials have been proposed, however we have compared one of the most popular, Jellonet with a bolster of proflavin-soaked cotton wool, to a newer dressing, Allevyn foam. PATIENTS AND METHODS: Sixty patients were recruited and randomised into either group. Any patient requiring surgery involving a split or full thickness graft due to be carried out in the outpatient department on any site was invited to participate. Outcome measures included percentage take, pain on dressing removal (visual analogue scale) and infection. Ethical approval was obtained from the North and Mid Essex Local Research Ethics Committee. RESULTS: There was no statistical difference in graft take between the two groups at day 5 (P=0.963). The Allevyn dressing was statistically more comfortable (P=0.0182). DISCUSSION: We propose that Allevyn foam provides an effective and comfortable method for securing small split and full thickness skin grafts. While offering equal levels of graft take, improved levels of comfort may lend itself to use in sensitive areas such as the nose, ear and around the eye.

Atypical congenital dermoids of the face: a 25-year experience.

OBJECTIVE: To review the presentation and management of nasal and other facial dermoid cysts and sinuses (excluding external angular dermoids). We report on 28 patients with less common facial dermoids. They presented as a cyst, sinus or both and may be separated into four groups. Group 1 (18 cases) were in the midline on the nose and many (12) had extensions to the septum but only two to the skull base. Group 2 (two cases) were paramedian nasal lesions and one extended through the nasal bones. Group 3 were lesions around the medial orbital wall, and two of these had tracts extending into the orbit. Group 4 were a miscellaneous group of lesions on the cheek and lips. We observed that preoperative imaging, although useful and done mainly for medico-legal reasons, may not detect deep extensions and therefore surgeons should be prepared for a more involved procedure when removing atypical facial dermoids.

A case of congenital megalourethra.

Congenital megalourethra is a rare anomaly of the penile urethra caused by a mesenchymal defect. We describe a baby boy with scaphoid type megalourethra and review the embryology and management of this condition.