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This study estimated the prevalence of independent flexor digitorum superficialis function in the small fingers of 90 violin and viola players. The hypothesis tested was that the independent digital movements required in this population would select out those with absent flexor digitorum superficialis function. Professional string players were tested clinically, using standard and modified tests, for flexor digitorum superficialis function. Two additional physical tests were applied: the gap and stretch tests. These tests assess ring finger movement once the small finger is placed and the instrument is held in the chin-hold position. A statistically significant reduction in the prevalence of absent flexor digitorum superficialis function was confirmed in the musicians compared with a control group and published meta-analysis. This suggests that independent flexor digitorum superficialis function is important for professional musicians playing at an elite level.

Aim: Perioperative Transversus abdominis plane (TAP) block has been well described in the literature as part of the multi-modal approach for management of postoperative pain in gynaecological and general surgery. The senior author started performing ultrasound-guided TAP block perioperatively in DIEP patients in January 2011. The role of surgeon-administered, intra-operative TAP block in abdominal based breast reconstruction surgery was investigated in terms of its efficacy, safety, ease of administration and impact on opioid-related usage and side effects profile., Methods: Retrospective analysis of a single surgeon's experience of patients undergoing autologous breast reconstruction using abdominally-based free flaps who received intra-operative, surgeon-delivered TAP block (n=12) compared with a similar patient set not receiving TAP block (n=15). Data was analysed using Student's t-test and assessed for significance of results using p<0.05 as the threshold of significance., Results: Patient's receiving TAP block had a significantly shorter length of stay (4.75 vs 7.00 days, p=0.002), lower usage of morphine (15.4 vs 71.4 mg, p=0.005), and fewer episodes of peri-operative nausea and vomiting (1 vs 6, p=0.03)., Conclusion: Perioperative ultrasound guided TAP Block is an effective, cost effective and safe technique for postoperative pain management in abdominal based breast reconstruction., (Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

A best evidence topic in surgery was written according to a structured protocol. The question addressed was whether, in patients undergoing an oesophagectomy for cancer, immediate postoperative enteral feeding (via percutaneous jejunostomy or nasojejunostomy) provides better patient outcomes as compared to waiting until oral feeding can be instituted. Four randomized controlled trials represented the best evidence to answer the clinical question. The first study randomized 25 patients into enteral feeding via jejunostomy (n = 13) versus a routine diet without jejunostomy (n = 12). The authors found no statistical difference in outcomes including length of stay, anastomotic complications and mortality. They did not report any catheter-related complications. A second study included patients undergoing an oesophagectomy or a pancreatodudenectomy, randomized to immediate postoperative jejunostomy feeding (n = 13) or remaining unfed for 6 days (n = 15). They reported one incident of detachment of the catheter from the abdominal wall. They also noted a statistically significant decrease in vital capacity and FEV1 in enterally fed patients. There was no difference in length of stay or anastomotic complications. They concluded that there was no indication for routine use of immediate postoperative enteral feeding in those patients without significant preoperative malnutrition. A third report randomized their post-oesophagectomy patients into enteral feeding via jejunostomy (n = 20) versus crystalloid only (n = 20). The also found no difference in length of stay, anastomotic leak rate or mortality. One catheter was removed due to concerns over respiratory function. They also concluded that there was no measurable benefit in early enteral feeding. The last of these 4 studies randomized patients into naso-duodenal feeding (n = 71) and jejunostomy feeding groups (n = 79). As in previous trials, they found no statistically significant difference between length of stay or anastomotic leak rates. Mortality was higher in the jejunostomy group, although the team did not attribute the deaths to the catheter. They found both methods equally effective in providing postoperative nutrition. In summary, all the trials concluded that routine postoperative enteral nutrition was feasible, but there was no evidence suggesting that it conferred any clinical benefits.

A best evidence topic in surgery was written according to a structured protocol. The question addressed was in patients undergoing elective major upper gastrointestinal surgery requiring post-operative nutritional support, does enteral feeding as compared to total parenteral feeding confer any clinical benefits. Thirty-two papers were identified by a search of the Medline and Embase databases, of which seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study group, relevant outcomes and results of these papers were tabulated. All seven of these papers were randomised controlled trials which demonstrated enteral nutrition to be associated with shorter hospital stay, lower incidence of severe or infectious complications, lower severity of complications and decreased cost as compared to parenteral nutrition. For patients undergoing elective major upper gastrointestinal surgery requiring post-operative nutritional support, enteral feeding should be considered as the most desirable form of post-operative feeding., (Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Objectives: Recent operational experience has led to the identification of several potentially serious adverse events related to the use of dietary and exercise supplements among British Army personnel. This study aimed to establish the point prevalence of dietary and exercise supplement usage in British soldiers on Op TELIC during January 2009., Methods: A cross-sectional questionnaire-based study of British military personnel located at the Contingency Operating Base (COB), in Basra, was performed during the sixth week of Op TELIC 13., Results: From 1544 questionnaires (target population) issued, a total of 1017 (65.9%) completed questionnaires were evaluated. The mean population age was 29.5 years (range 18-58) of which 87.4% were male. 417/1017 persons (41.0%) admitted to a history of supplement use of which 32.0% were current users and 9.4% were previous users. Of these current users, 66.0% started taking them on their current deployment. The most commonly taken supplements were whey protein (18.8%), amino acids (17.9%), and creatine (13.2%). There were 14 persons (1.4%) who admitted to current use of anabolic steroids. The most-frequently given reasons for taking supplements were either to 'increase muscle bulk' (40.4%) or to aid training and recovery (20.8%)., Conclusions: This is the first study to investigate the use of exogenous nutritional supplements within the British Military and has identified their widespread use during operational deployment. The use of anabolic steroids is particularly worrying, given both their illegality and their well-recognised and deleterious health effects. There is a need for greater awareness and education regarding potential benefits and dangers of supplement use in order to maximise any potential benefits and minimise clinical risk.