Search

Purpose: Complications of incisional hernia are amongst the commonest presentations to the emergency surgical take. Outcomes from emergency hernia repair are poor, particularly for those with complex defects and for the growing population of comorbid, high-risk patients. Attempts to avoid emergency surgery by improving success rates of non-operative management could prove hugely beneficial. Botulinum toxin A (Botox) is already used in the elective management of incisional hernia and this study evaluates if the relaxation produced could be used to augment the outcomes of conservative management of acutely presenting incisional hernia. Methods: Patients presenting between October 2020 and April 2022 without evidence of visceral ischaemia, who had been selected for a non-operative approach, were given 300 units of Botox under image guidance to the abdominal wall in addition to standard conservative measures. Results: Twelve patients were eligible for Botox administration. Median age was 75 years and median BMI was 36.45 kg/m2. All patients were high risk; minimum ASA score was 3, and median frailty score was 5. In ten patients, symptoms resolved following Botox allowing for discharge without further complication. Seven subsequently referred on to the abdominal wall team. Symptoms did not settle in the two remaining patients; one required emergency laparotomy and the second was palliated. Conclusion: Botox may be a useful adjunct to established non-operative measures in patients with acute presentations of incisional hernia. It may improve the acute symptoms, eliminate the need for high-risk emergency surgery, or provide a bridge to abdominal wall reconstruction. [ABSTRACT FROM AUTHOR]

To assess the impact of intrapleural urokinase and small tube thoracostomy on the management of childhood empyema thoracis. The study population included 38 children presenting consecutively to a regional surgical unit with empyema thoracis from January 2001 to December 2003. Children with malignancy, immunodeficiency and complex intercurrent illness were excluded. Primary outcome variables were the need for second intervention and duration of stay, with other variables including duration of antibiotics, serial CRP and amelioration of pyrexia. Interventions were: tube thoracostomy (16-20 Fr) alone (n=2), tube thoracostomy (6-10 Fr)+urokinase (n=17), thoracoscopy (tube: 20-24 Fr) (n=9), thoracotomy (tube: 16-24 Fr) (n=10). There were no differences in age, weight or length of prodromal symptoms, between treatment groups. There were no differences in primary outcome variables, although no child undergoing thoracotomy required further intervention. The duration of intravenous antibiotics was similar in all groups. Amelioration of pyrexia was more rapid in children undergoing thoracotomy. There were no differences seen with regard to decline in CRP level. Small tube thoracostomy and intrapleural urokinase had a similar outcome to more invasive therapies such as thoracotomy or thoracoscopy thereby supporting the evidence base for urokinase and tube drainage as first line intervention. [ABSTRACT FROM AUTHOR]

Threshold concepts were introduced nearly 10 years ago by Ray Land and Jan Meyer. This work has spawned four international conferences and hundreds of papers. Although the idea has clearly gained traction in higher education, this sub-field does not yet have a fully fledged research methodology or a strong critical discourse about methodology. This paper seeks to begin such a dialogue by analysing three projects carried out by the authors, each focused broadly on identifying and understanding threshold concepts in engineering. Each of the projects used interviews with students and academics, but differed in six main ways that seem to make a difference to the research outcomes. This paper considers the gaps in the research and why they matter, briefly outlines the methods used in each of the three case study projects, and then discusses differences in project goals, researchers' backgrounds, curricular context, participants' experiences, negotiated or independent knowledge and degree of comprehensiveness sought in the studies. The implications of these six differences are explored. The authors argue that research in this sub-field of higher education pedagogical research needs to be clearer and more explicit about the methods that are used They conclude that the field would benefit from bringing together researchers who have been developing complementary research methods to compare and contrast these approaches and to develop more rigorous protocols for research on threshold concepts. [ABSTRACT FROM AUTHOR]

This study aimed to define the incidence, causative organisms and predisposing factors leading to infection related morbidity in newborns with gastroschisis. All gastroschisis patients admitted over the 5-year period (1999-2004) were retrospectively reviewed. Surveillance samples, wound, blood, urine and fecal cultures were analyzed. Duration of total parenteral nutrition, antibiotic therapy, feeding regimes and demographic data were also analyzed. Multiple logistic regression was employed using the SPSS system and p < 0.05 was considered as significant. Seventy-two neonates were identified with 53% having abnormal gut carriage mostly due to Enterobacter and Klebsiella. Wound infection occurred in 20% of cases. Abnormal gut carriage predisposed to the development of wound infection. Line sepsis occurred in 21% of neonates. Endogenous coagulase negative Staphylococcus caused 74% of septic episodes. There was no correlation between abnormal gut carriage and the development of line sepsis. Overall survival was 96%. The cause of infections in gastroschisis patients appears to be multifactorial. A multidisciplinary team can play an important role in reducing the incidence of infections. Strict aseptic protocols and auditing practice can be the invaluable tools in decreasing morbidity rates. [ABSTRACT FROM AUTHOR]

Clinical presentation and microbiology profiles of neutropenic paediatric oncology patients presenting with ecthyma gangrenosum (EG) were studied. Surgical strategies deployed for these critically ill children are reported. Between 1994 and 2005, all children with EG were identified. Case notes were reviewed. Hospital course and long-term outcome were documented. Ten patients were identified. Eight had acute lymphoblastic leukaemia, one child had acute myeloid leukaemia and another had rhabdomyosarcoma. Lesions occurred in the perineal region (n = 5), buttocks (n = 2), thigh (n = 2) and the face (n = 1). Seven children had positive blood cultures for Pseudomonas aeruginosa. Surgery included (1) radical debridement, and (2) debridement with covering colostomy for four of those with perianal lesions. Ecthyma gangrenosum is a rapidly spreading and potentially lethal condition. Paediatric oncology patients with neutropenia are at a high risk. Surgical excision is crucial for progressive lesions to prevent mortality. [ABSTRACT FROM AUTHOR]

Relationships between manufacturing processes, microstructures, mechanical and tribological properties of GF/PA6 composite were revealed in this paper by experimental investigations and theoretical analysis. The study indicated that the wear resistance was significantly influenced by the thermal history of the composite. Decreasing cooling rate during the components thermal moulding would result in enhancing approximate 28% of wear resistance and reducing almost 14% of friction in the GF/PA6 composites. A slow cooling gives the PA6 a high crystallinity and high ratio of α/γ phases which resulted in higher thermal stabilities, higher density and harder matrix in the composites than that of fast cooling. It also improves the interfacial properties and the composite hardness. Due to the thermal decomposition, abrasion and adhesion dominated the wear mechanisms, these improvements led to a higher wear resistance and higher pv service limit in the slow cooled GF/PA6 samples than that of fast cooled samples. Interfacial debonding dominated the friction mechanisms in the unlubricated pin-on-disk tests. A poor interfacial bond led to more glass fragments falling off from the GF/PA6 pins which scratched the sliding surfaces, damaged the oxidative film and resulted in severe abrasion and adhesion in the fast cooled samples, hence leading to a high friction coefficient. [ABSTRACT FROM AUTHOR]

The following paper summarises a number of international research projects being undertaken to understand the mechanical properties of natural cellulose fibres and composite materials. In particular the use of novel techniques, such as Raman spectroscopy, synchrotron x-ray and half-fringe photoelastic methods of measuring the physical and micromechanical properties of cellulose fibres is reported. Current single fibre testing procedures are also reviewed with emphasis on the end-use in papermaking. The techniques involved in chemically modifying fibres to improve interfacial adhesion in composites are also reviewed, and the use of novel fibre sources such as bacterial and animal cellulose. It is found that there is overlap in current international research into this area, and that there are complementary approaches and therefore further combining of these may make further progress possible. In particular a need to measure locally the adhesion properties and deformation processes of fibres in composites, with different chemical treatments, ought to be a focus of future research. [ABSTRACT FROM AUTHOR]

The environmental degradation behaviour of flax fibres and their polymer composites are explored. New upgraded Duralin flax fibres, which have been treated by a novel treatment process for improved moisture and rot sensitivity were studied. Environmental studies showed that these upgraded Duralin flax fibres absorb less moisture than untreated Green flax fibres, whereas the mechanical properties of the treated fibres were retained, if not improved. The effect of this novel flax fibre treatment on the environmental behaviour of natural-fibre-mat-reinforced thermoplastics (NMTs) is investigated by monitoring the moisture absorption and swelling, and measuring the residual mechanical properties of the flax/polypropylene composites at different moisture levels. The moisture absorption and swelling of the upgraded flax fibre composites is approximately 30% lower than that of composites based on Green flax fibres. [ABSTRACT FROM AUTHOR]

Presents a study which investigated genetic variation between algal isolates from giant clams using the random-amplified-polymorphic DNA patterns of Symbiodinium isolates. Materials and methods; Results and discussion.

Smith-Lemli-Opitz syndrome (SLOS) is a syndrome of rare multiple congenital anomalies/mental retardation associated with low plasma cholesterol levels. Prior to receiving the diagnosis of SLOS, affected children may present as a neonatal surgical emergency with ambiguous genitalia, Hirschsprung's disease, and pyloric stenosis. We present two fatal cases of SLOS with near-total Hirschsprung's disease; the surgical, anaesthetic, and medical aspects of the cases are discussed, and a literature review is presented. [ABSTRACT FROM AUTHOR]

A case of childhood cutaneous angiosarcoma is presented to emphasize the importance of accurate histological diagnosis in lymphovascular malformations that behave atypically and to review the natural history, aetiology, and differential diagnosis of this condition. [ABSTRACT FROM AUTHOR]