Assuntos
Fraturas Ósseas/complicações , Luxações Articulares/complicações , Ossificação Heterotópica/complicações , Polegar/cirurgia , Dedo em Gatilho/etiologia , Traumatismos do Punho/complicações , Adulto , Seguimentos , Humanos , Masculino , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/cirurgia , Tendões/cirurgia , Dedo em Gatilho/diagnóstico , Dedo em Gatilho/cirurgiaRESUMO
INTRODUCTION: This study was designed to: (i) determine if the priority of referral letters by general practitioners to a plastic surgery skin lesion clinic adhered to the national guidelines, what happened to these patients, and what was the histological diagnosis; and (ii) analyse whether the prognosis at diagnosis of malignant melanoma had improved since the introduction of the 2-week wait for patients with suspected cancer. MATERIALS AND METHODS: The study involved a prospective audit questionnaire, retrospective note review and histology report review in the Plastic Surgery Department in a district general hospital and their 'bespoke' out-patient clinics. RESULTS: Of 202 referral letters, 58 (29%) were referred as 2-week cancer referrals of which 13 (22%) suggested diagnoses that did not fall within the guidelines, and 11 gave no diagnosis. In addition, 84 (42%) had no indication of priority, though the text may suggest the need for it, either explicitly or implied. The prognostic indices for malignant melanoma have not altered since the 2-week wait rule has been implemented. CONCLUSIONS: The guidelines are not being adhered to, thus patients with benign lesions are being given undue priority. The history and examination of skin lesions given in the referral letters is insufficient to allow the consultant to prioritize. Since the 2-week rule has be implemented, malignant melanomas have not been diagnosed at an earlier stage.
Assuntos
Correspondência como Assunto , Medicina de Família e Comunidade/normas , Ambulatório Hospitalar/organização & administração , Encaminhamento e Consulta/normas , Dermatopatias/diagnóstico , Agendamento de Consultas , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Prioridades em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prognóstico , Encaminhamento e Consulta/estatística & dados numéricos , Neoplasias Cutâneas/diagnósticoRESUMO
We report a very rare case of a high flow arteriovenous malformation (AVM) of the upper limb that caused high output cardiac failure at birth. There was early transfer of the baby to the care of a multidisciplinary team. After radiological intervention, the arm distal to the malformation became ischaemic and an urgent amputation through the upper-humerus followed. Methods of treatment are discussed, together with a review of results in the literature.
Assuntos
Braço/irrigação sanguínea , Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Pele/irrigação sanguínea , Amputação Cirúrgica , Malformações Arteriovenosas/diagnóstico por imagem , Humanos , Recém-Nascido , Masculino , Radiografia , Torniquetes , Falha de TratamentoRESUMO
The Data Protection Act 1998 came into force in March 2000 and has significant implications on our normal practice. A survey of surgical specialist registrars was made to establish knowledge of the Act and adherence to its eight principles. Knowledge was patchy and adherence minimal, Simple guidelines are suggested to help juniors keep within the principles of the Act.
