Gracilis myocutaneous flap for reconstructing perineal defects resulting from radiation and radical surgery

When high-dose radiotherapy for carcinoma of the rectum, cervix, vagina or vulva fails and subsequent surgical excision by extended abdominoperineal resection or exenteration is performed, healing is often greatly delayed, for many months, and a scarred, deformed perineum results. The introduction of myocutaneous flaps opened up a new field for reconstruction of defects in a number of areas. The authors used a gracilis myocutaneous flap in 15 patients for primary reconstruction following surgical resection for failed radiotherapy of a primary carcinoma (of the rectum in 6, the cervix in 7 and the vulva in 2) and as a secondary procedure in 2 patients, 1 with an unhealed perineum 4 months after irradiation and extended abdominal resection for carcinoma of the rectum, and the other with extensive perineal necrosis following radiotherapy and chemotherapy. The operative technique, which is relatively simple, is described and illustrated. Since all patients had received radiotherapy, the myocutaneous flap was used primarily and successfully to reduce morbidity and healing time. However, even without radiotherapy, the deformity following exenteration is unacceptable and reconstruction by the method described should probably be planned as part of this operation. Not only can primary healing be expected, but the neovagina has a relatively normal appearance with satisfactory sensation and function.     

Pseudotumor cerebri.

Pseudotumor cerebri is a clinical syndrome in which signs and, sometimes, symptoms of raised intracranial pressure are present but in which mental and neurological function are unaffected. Therefore, the diagnosis is reached after mass and other structural causes of raised pressure have been excluded. Many causes of pseudotumor have been suggested, not all of them well documented. Pathogenesis, however, includes cerebral edema, increased cerebral blood volume, and decreased cerebro spinal fluid (CSF) absorption. Except for the risk of vision in a minority of cases, the prognosis is excellent.     

Team working to improve outcome in vestibular schwannoma surgery

The concept of the 'learning curve' in the early years of consultant appointment is no longer acceptable and yet, for most complex operations, learning is a career-long process. Sub-specialization offers part of the solution to this problem by concentrating expertise, but there remains the question of how to introduce new team members without adversely affecting patient outcome. Shortened training and an increasingly aware public, who are more questioning of the experience and outcomes of those treating them, has required the surgical profession to move away from individual consultant practice and embrace team-working. When, in 1997, a second neurosurgeon joined the skull base team at Addenbrooke's Hospital, his introduction to acoustic neuroma surgery was mentored and operative cases were carefully selected at first. In this article, we discuss our experience with consultant mentoring, and compare the results of the first 100 translabyrinthine acoustic neuroma operations performed under this system with the first cohort of a similar number of patients published from Cambridge in 1989.     

Continuous arterial spin labeling using a train of adiabatic inversion pulses

PURPOSE: To develop a simple and robust magnetic resonance imaging (MRI) pulse sequence for the quantitative measurement of blood flow in the brain and cerebral tumors that has practical implementation advantages over currently used continuous arterial spin labeling (CASL) schemes. MATERIALS AND METHODS: Presented here is a single-coil protocol that uses a train of hyperbolic secant inversion pulses to produce continuous arterial spin inversion for perfusion weighting of fast spin echo images. Flow maps of normal rat brains and those containing a 9L gliosarcoma orthotopic tumor model conditions were acquired with and without carbogen. RESULTS: The perfusion-weighted images have reduced magnetization transfer signal degradation as compared to the traditional single-coil CASL while avoiding the use of a more complex two-coil CASL technique. Blood flow measurements in tumor and normal brain tissue were consistent with those previously reported by other CASL techniques. Contralateral and normal brain showed increased blood flow with carbogen breathing, while tumor tissue lacked the same CO(2) reactivity. CONCLUSION: This variation of the CASL technique is a quantitative, robust, and practical single-coil method for measuring blood flow. This CASL method does not require specialized radiofrequency coils or amplifiers that are not routinely used for anatomic imaging of the brain, therefore allowing these flow measurements to be easily incorporated into traditional rodent neuroimaging protocols.     

Undergraduate students' attitudes to communication skills learning differ depending on year of study and gender

The authors wished to assess medical students' attitudes towards communication skills learning, and to validate the use of the Communication Skills Attitude Scale (CSAS) in a different population. This cross-sectional study of Years 1-3 MBChB students, University of Aberdeen, in 2002-03 (overall response rate=86.2%) identified significant differences in attitudes to communication skills teaching by year of study and gender. PAS (positive attitudes scores) for Year 1 were significantly higher than those for Years 2 and 3. NAS (negative attitudes scores) for Year 1 were significantly lower than the scores for Year 2 but not Year 3. The scores for Years 2 and 3 were not significantly different. Female students had a significantly higher mean PAS score and lower mean NAS score than males, and were more likely to disagree that their communication and clinical skills were competent. While cohort effects may be present, it seems that attitudes towards communication skills learning are positive initially, becoming less so until students experience interacting with patients. Differences between male and female students reflect those seen in previous studies. The findings presented support the use of the CSAS as an appropriate tool to measure attitudes in a wide population of medical students.     

Serum antibody to poliovirus in patients in a mental deficiency hospital, with particular reference to Down's syndrome.

Neutralization tests for poliovirus antibodies were carried out on 74 patients in an adult mental deficiency hospital: 37 patients with Down''s syndrome and 37 non-Down''s mental defectives. The distribution of antibody titres to poliovirus types 1, 2 and 3 did not differ significantly between the two groups. Most patients had antibody to at least one poliovirus type but less than a third had antibodies at a titre of 1/8 or greater to all three types. The low level of poliovirus immunity in this population may be of epidemiological importance.