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Raynaud's phenomenon is a vasospastic condition affecting hands and feet which may lead to rest pain, ischemic ulcers and gangrene. Botulinum toxin A has been shown to improve peripheral circulation and relieve vasospastic symptoms. Our aim was to assess our treatment outcomes following Botulinum toxin A injections in patients with Raynaud's phenomenon and to explore the importance of toxin concentration and injection sites. Retrospective chart review of patients with primary and secondary Raynaud's syndrome treated with Botulinum toxin A injections and a literature review was conducted. The toxin dose, injection sites, symptom relief, healing of ulcers and complications were assessed. A total of 30 treatment episodes over a 7½ year period were included. All patients had failed medical management. Botulinum toxin A injection was injected primarily in the vicinity of the palmar digital neurovascular bundle. The average total Botulinum toxin A dose injected was 156 U and the concentration was 50 U/ml. All patients reported an improvement in symptoms and healing of digital ulcers. One patient reported a temporary muscle weakness. Six patients had a single treatment episode with long term benefit. Systemic sclerosis patients had an average of 6-month interval between treatment episodes. Higher doses of Botulinum toxin A has been well tolerated with no long term adverse effects. Our study shows that targeted low volume higher concentration Botulinum toxin A injections are effective in treating Raynaud's phenomenon. [ABSTRACT FROM AUTHOR]

Introduction: Accurate assessment and resuscitation of a major burn injury is a difficult task for inexperienced clinicians, yet essential for patient outcome. The commonly used Lund and Browder Chart (LB) offers an accurate tool but is the start of a series of 19 calculations required to begin fluid resuscitation at the bedside. 'Mersey Burns' (MB) is an Application (App) for use on smartphones and tablets designed to improve the assessment and resuscitation of adults and children following burn injury. The App allows clinicians to shade the burn pattern onto the screen in real time, and then generate detailed fluid protocols as well as an email that can be sent to a receiving Burns Unit. The study evaluated the effectiveness of this technology compared to current paper based methods (LB). Methods: Under ethical approval, Senior Undergraduate Medical Students with no previous experience of burns management were recruited from the Liverpool University. Students were given a one-hour lecture on burn management and fluid resuscitation involving demonstrations of both the LB and Mersey Burns application. They then assessed a simulated patient with 20% Total Body Surface Area (TBSA) burn devised by Whiston Hospital Prosthetic Department. Students then assessed the size of burn and calculation fluid resuscitation timed using both LB with a calculator, and MB. Students completed surveys assessing ease of use, confidence in output, preference in the emergency setting, speed, accuracy, ease of calculation and ease of shading of the two methods. Statistical analysis comprised one-way-ANOVA, student t-tests and chi-square tests. Results: 30 students took part. The variation in TBSA between students was similar between LB and MB (p=0.39). Average time of calculation was 11.8 minutes for LB and 4.6 minutes for MB (p<0.05). Total fluid volumes, were more likely to be correct using MB than LB (p<0.05). Students were more confident in the output, found calculations easier to perform, found overall use easier, felt accuracy to be superior, found ease of shading to be superior and felt that calculations were quicker using MB (p<0.05). Discussion and Conclusions: Early, accurate assessment of major burn injury saves lives. The challenge is to support doctors in Emergency Departments, who encounter serious injuries infrequently, to rapidly assess, treat and transfer. Our solution is to harness agile technology using tablets and smartphones to manage these patients and share the details with a receiving Burns Unit by email. Mersey Burns is the first UK Healthcare App carrying a CE Mark from MHRA. It allows fluid calculations to be performed more quickly and accurately than Lund and Browder charts when used by burns care naive medical students. Students found the application to be easier, quicker and more accurate to use and would prefer to use it in the emergency setting. This suggests a useful role for the App in the care of burns patients by inexperienced staff providing both confidence and timely delivery of care. It further highlights the novel use of technology to train the next generation of burns care clinicians. [ABSTRACT FROM AUTHOR]

Introduction: Amniotic constriction bands occur in approximately one in every 15,000 live births and is graded using the Patterson Classification system. Methods: A case series of all patients with amniotic constriction band that presented to Alder Hey Children's Hospital was compiled between the years 1993 and 2012, data was described and a classification system developed. Results: Thirty seven patients were identified. Of these 17 had amniotic constriction confined to the upper limbs and three of the lower limbs only. Seventeen had both upper and lower limb deformity. Twenty eight children underwent surgical intervention whilst nine to date have not. Conclusion: Constriction band of the upper limb was the most common with lower limb bands the least. There is no agreement on the nomenclature of this condition making amalgamation of the literature problematic. A more specific classification of upper limb bands has been suggested which includes anatomical location and depth of band. [ABSTRACT FROM AUTHOR]

The term rat bite fever (RBF) designates pyrexia and systemic disease caused by the gram-negative bacteria Streptobacillus moniliformis, common in North American and European rats, and transmitted by their bite. Despite low transmission rates of 10%, this systemic disease has a mortality of around 15% when untreated and has serious consequences for at risk populations such as the immune compromised. [ABSTRACT FROM AUTHOR]

This report presents a girl with a lipoblastoma of a finger presenting as a macrodactyly. Documented inflammation of the digit at birth raises suspicion of neo-adipogenesis, which is recognised in lipomas. This case highlights a rare site for lipoblastomas and explores a potential aetiopathogenesis. [ABSTRACT FROM AUTHOR]