Biomedical subjects
Publications and source records attributed to A C Macey.
We report three cases of flexor sheath infection due to Streptococcus milleri in two patients. Soft tissue damage was extensive despite surgical debridement and appropriate antibiotic therapy. One patient had two digits amputated and the other had the affected digit amputated at the level of the proximal interphalangeal joint. These cases illustrate the potential pathogenicity of a bacterium which is often regarded as a commensal.
Acute swelling of the hand is a common problem after trauma or surgery and is associated with both pain and loss of function. We describe a prospective study of 47 patients in which we assessed the effects of a pneumatic compression device (A-V impulse hand pump) on the swollen hand. The pump reduced swelling by increasing the velocity of venous return as demonstrated by Duplex scanning of the median cubital vein. Continuous use of the pump for 48 hours gave a reduction of 78.6% in swelling of the injured hand compared with the opposite, uninjured side. Even when used intermittently, with the pump on for 12 hours out of 24, a statistically significant effect was seen. There was a subjective reduction in pain and an objective improvement in function of the hand. Use of the pump resulted in a nearly normal hand by the time of discharge from hospital after, on average, 48 hours.
The findings are presented of a conference on Outcomes of Hand Surgery organized by the audit committee of British Society for Surgery of the Hand in 1993. Measures of outcome in terms of movement, power, sensibility, pain, activities of daily living, complications and patient satisfaction are considered, and an example of a patient evaluation measure given as an appendix.
A review of the results of arthroscopies on patients taken from an 'open access' service waiting list has been carried out. One-third of all arthroscopies proved to be negative. Accuracy of clinical diagnosis was not related to the clinical grade of the examining doctor. The excess annual cost to the Northern Ireland Orthopaedic Service of unnecessary arthroscopies may have been of the order of 89,000 pounds.
The Abbreviated Injury Scale (AIS) score and the Injury Severity Score (ISS) were calculated for all passengers and crew of the M1 Kegworth aircraft crash. Regional injury scores were significantly higher in nonsurvivors than survivors of the impact. Mortality and ISSs were found to correlate with the structural damage sustained by the aircraft. The use of injury scoring has highlighted variations in the severity of injuries sustained by occupants involved in an impact crash of an airliner. This information has demonstrated that other factors in addition to the force of the impact were involved in the causation of injury, such as structural integrity, attempts by occupants to protect adjoining passengers, and rear-facing seats.
The 79 survivors of the M1 aircrash have been assessed at an average of great britain 1 year after the accident. Return to work, continued hospital care and recovery from injuries has been found to be related to the severity of injury. The 188 pelvic and limb fractures have been reviewed and the incidence of complications from these injuries has been low. Spinal and lower limb injuries account for the majority of the residual disability.
Stem fractures in prosthetic femoral components are a well recognized problem. More recently neck fractures have been described. An unusual case of a 'sub-capital fracture' in a femoral component is described.
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