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J H Laing

Publications and source records attributed to J H Laing.

15 recordsLinked to original sources
PubMed2001

Vaccum assisted closure: an alternative strategy in the management of degloving injuries of the foot.

A case of a degloving injury to the foot is presented in a patient who also sustained severe contralateral lower-limb trauma. We report a technique for salvaging the foot by replacing the degloved skin as a full-thickness graft and securing it using the vacuum-assisted closure (VAC) device. A good outcome was achieved and technical tips are provided to facilitate reproduction of the procedure.

Bone Wires↗
PubMed2000

Coding plastic surgery operations: an audit of performance using OPCS-4.

Accurate coding is essential for local and national data reporting and for contracting. It is also integral to clinical governance. This study aimed to assess the accuracy of coding in Morriston Hospital plastic surgery theatres and coding office, to reaudit and address poor practice. A third coding system, a computerised logbook developed by the senior author, was not analysed in this study. Fifty operations coded using OPCS-4 were compared with a gold standard for overall accuracy, primary and procedural codes. Results were discussed with all relevant staff and reaudit took place 3 months later. The data were analysed using the paired Student's t -test for intergroup comparisons and the unpaired test for intragroup assessment. At initial audit, the coding office was significantly better than theatre staff in overall accuracy (78% vs 43% respectively P<< 0.01) and in procedural codes (98% vs 42%, P<< 0.01) but there was no difference in primary codes (62% vs 74%). At reaudit the only significant improvement was in overall accuracy of coding office records, although the clinical coders were now significantly better at recording primary codes than theatre staff (76% vs 56%, P< 0.05). The conclusions were that the quality of coding in theatre was poor and should stop. Clinical coders performed better but 1/3-1/4 of essential codes were inaccurate. This may have been due to limited understanding of terminology and techniques, difficulty reading operation notes and complexity of OPCS-4. Recommendations included closer cooperation between surgeons and coders to support and improve clinical coding performance.

Forms and Records Control↗
PubMed1996

Regeneration through a long nerve graft used in the correction of facial palsy. A qualitative and quantitative study.

A surgical technique has been developed for the correction of established unilateral palsy in man. A long (20 cm or more) sural nerve graft is anastomosed to a facial nerve branch on the unaffected side and its distal end left lying free in the cheek of the affected side. After regeneration times of 5.5-14.5 months, the distal end of the graft is joined to a free (pectoralis minor) muscle graft. In due course the muscle graft contracts in unison with the unaffected side giving near normal symmetry to facial movements. In 30 cases (ages 6-52 years) qualitative and quantitative examination was made of the distal end of grafts taken at the time of joining the graft to the muscle. Total axon counts, myelinated plus non-myelinated, confirmed abundant regeneration when compared with total axons in the supplying facial nerve; myelinated fibres remained small (mean diameter 2.5 micrometers) over the range of regeneration times. Quantitation included non-myelinated axons because they probably have the potential to become myelinated once the nerve is functional. Numbers of regenerating axons were not correlated with age, nor with regeneration time. Lack of a distal connection did not appear to lead to secondary degeneration of the regenerated myelinated fibres. These were maintained in an 'immature' state for many months. This observation is of practical interest since it has been suggested that delayed connection to the distal target may have a deleterious effect on the outcome of the procedure.

Adolescent↗
PubMed1996

Is permanent congenital facial palsy caused by birth trauma?

OBJECTIVE: To study the relation between traumatic birth and the development of permanent facial palsy in the newborn. DESIGN: Retrospective case control study of children with 'congenital' facial palsy. SETTING: Two tertiary referral centres for patients with facial palsy. SUBJECTS: 61 children with established facial palsy. MAIN OUTCOME MEASURES: Odds ratios of recognised factors for birth injury: maternal primiparity, high birth weight, and the use of obstetric forceps at delivery. RESULTS: 13.2% of those studied had forceps assisted delivery compared to 10.2% in the normal population (odds ratio 1.34; 95% confidence intervals 0.61 to 2.97) 39.6% were born to primiparae compared to a national rate of 36.7% (1.13; 0.65 to 1.96) and only 18.9% weighed more than 3500 g at birth (0.37; 0.19 to 0.74). CONCLUSIONS: There is no association between the development of permanent 'congenital' facial palsy and recognised risk factors for birth injury. These data suggest an intrauterine rather than a traumatic aetiology.

Birth Injuries↗
PubMed1996

Hypospadias repair: the influence of postoperative care and a patient factor on surgical morbidity.

More than 200 surgical techniques have been advocated for hypospadias repair and perfection is still eluding us. The purpose of this paper is not to comment on a surgical technique, but to highlight the importance of postoperative care on the eventual surgical outcome. Two hundred six children undergoing primary hypospadias surgery from 1984 to 1994 at Mount Vernon Hospital were analyzed. The mean age of surgery was 3.8 years (range, 8 months-17 years) and our mean follow-up was 6.1 years. Various surgical techniques were used. During 1989, we changed our postoperative regime and patients were mobilized early (within 48 hours) compared to the strict-bed rest-till-catheter-out regime before 1988. This significantly reduced our fistula rate from 22% to 9.8% (chi squared p = 0.0016). Patient factors such as pulling on the catheter, urinary obstruction/blocked catheter, erections, straining due to constipation, and interference with dressings influence surgical outcome negatively. One of these patient factors was documented in all of our 33 patients who developed fistulas. In 6 patients (3.5%), a patient factor was present without any complication. This is highly significant statistically (chi squared p < 0.0001). The type of urinary diversion, period of urinary diversion, type of dressing, catheter size, and anesthetic regime did not influence outcome significantly.

Adolescent↗
PubMed1993

The Misti Gold bio-oncotic gel filled breast prosthesis: an acceptable alternative to silicone?

Concern about the use of silicone gel as a filler for breast prostheses has stimulated interest in other materials. We have evaluated the Misti Gold prosthesis which contains a "bio-oncotic" gel of low molecular weight Polyvinylpyrrolidone (PLASDONE 24AUK). Our experience of its use in breast augmentation is that the aesthetic results obtained with retromammary placement are inferior to those obtained from a silicone gel filled prosthesis. Nonetheless there are theoretical advantages for its use which will need to be considered in the light of recent regulatory decisions.

Female↗
PubMed1993

Risk of cancer in relatives of patients with cutaneous melanoma.

BACKGROUND: Cutaneous malignant melanoma (CMM) is a recognized feature of the Lynch type II cancer-family syndrome and the Li-Fraumeni's syndrome. A significant contribution of these syndromes to the total burden of CMM would be reflected in an increased risk of nonmelanoma cancers in first degree relatives. METHODS: Pedigrees were taken from 85 patients with CMM using a family history questionnaire. The relative risk of death from all cancers and individual cancers in first degree relatives was calculated. RESULTS: Of the 85 questionnaires, those of 79 patients were completed and of adequate quality for analysis. The first degree relatives of CMM patients showed no increased risk of cancer death, the relative risk of cancer death being 1.0. Six patients (7.6%) had first degree relatives with CMM. One patient had a family history compatible with the dominant transmission of a predisposition to cancer. CONCLUSIONS: It is important to establish whether an increased cancer risk is present in relatives of patients with malignancies so that screening programs may be offered. This study provides little evidence to support seeing relatives for noncutaneous malignancies in the absence of a dominant family history of predisposition to cancers. The increased frequency of CMM in relatives suggests that relatives of CMM patients should be counseled on protection from the sun and examination of the skin for melanoma.

Adult↗
PubMed1992

The exposed total knee replacement prosthesis: a new classification and treatment algorithm.

The increased frequency of total knee replacement arthroplasty (TKRA) has been reflected in the number of patients with exposed prostheses referred to this unit. An algorithm has been developed to assist in the preoperative assessment of the wound and this has been tested on 25 patients with wound breakdown following TKRA. The grade of exposure so derived predicts the most appropriate surgical management. The algorithm, grading system and proposed management are described.

Algorithms↗
PubMed1992

Tumour proliferation assessed by combined histological and flow cytometric analysis: implications for therapy in squamous cell carcinoma in the head and neck.

The two techniques of flow cytometry analysis (FCM) and immunohistochemical localisation of bromodeoxyuridine (BrdUrd) incorporation after in vivo administration, were combined to study proliferation in squamous cell carcinoma of the head and neck region. Care was taken in this study to ensure that similar material was processed using both techniques such that comparisons could be made. FCM underestimated the labelling index (LI) in tumours classified as diploid compared to the histological evaluation of the tumour cells within those tumours (4.6% vs 17.1%). However, in aneuploid tumours, the FCM LI (10.7%) was similar to that obtained from histology (13.5%). Indeed, proliferation assessed by the combination of histology LI and FCM duration of S-phase (Ts) indicated that diploid tumours had a shorter median potential doubling time (Tpot) of 2.1 days compared to aneuploid (2.8 days). Despite the heterogeneity of proliferation evident histologically within the specimens, there was not a wide variation in the results of FCM analysis when multiple samples from resections were studied. Using FCM data alone, 46% of the tumours showed a Tpot of less than 5 days. When the Ts from the FCM data was combined with the average histological LI, 84% were less than 5 days and with the maximum LI, 99% were within this time interval. Compared with previous estimates, the proportion of tumours possessing proliferative characteristics which may indicate the need for acceleration of treatment seems to be much larger.

Aneuploidy↗
PubMed1992

Malignant change in trichilemmal cysts: a study of cell proliferation and DNA content.

We have examined proliferative activity in a series of pilar and trichilemmal cysts using an antibody to proliferating cell nuclear antigen. In benign lesions proliferative activity was confined to the basal layers of the squamous epithelium. Lesions showing malignant change showed increased proliferative activity and were not confined to the basal layer. These findings were correlated with studies on DNA content using flow cytometry.

Adolescent↗
PubMed1991

Assessment of burn injury in the accident and emergency department: a review of 100 referrals to a regional burns unit.

Accurate assessment of the extent of thermal injury in the accident and emergency (A&E) department is essential if appropriate resuscitation and referral to a specialist unit is to occur. However, review of 100 referrals to a regional burns unit confirms that assessment is often inaccurate, and usually undertaken by no one more senior than a casualty officer, leading to suboptimal treatment and referral. Severe thermal injury should be assessed by a team of senior doctors, according to the major trauma protocol, and casualty officers should receive better training in the assessment of less extensive burns.

Burn Units↗
PubMedDate not supplied

Structure of type I and type III heterotypic collagen fibrils: an X-ray diffraction study.

The molecular packing arrangement within collagen fibrils has a significant effect on the tensile properties of tissues. To date, most studies have focused on homotypic fibrils composed of type I collagen. This study investigates the packing of type I/III collagen molecules in heterotypic fibrils of colonic submucosa using a combination of X-ray diffraction data, molecular model building, and simulated X-ray diffraction fibre diagrams. A model comprising a 70-nm-diameter D- (approximately 65 nm) axial periodic structure containing type I and type III collagen chains was constructed from amino acid scattering factors organised in a liquid-like lateral packing arrangement simulated using a classical Lennard-Jones potential. The models that gave the most accurate correspondence with diffraction data revealed that the structure of the fibril involves liquid-like lateral packing combined with a constant helical inclination angle for molecules throughout the fibril. Combinations of type I:type III scattering factors in a ratio of 4:1 gave a reasonable correspondence with the meridional diffraction series. The attenuation of the meridional intensities may be explained by a blurring of the electron density profile of the D period caused by nonspecific or random interactions between collagen types I and III in the heterotypic fibril.

Animals↗