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Biomedical subjects

M A Milling

Publications and source records attributed to M A Milling.

At least 19 recordsLinked to original sources
PubMed1999

Heparin-induced skin necrosis and low molecular weight heparins.

Heparin-induced skin necrosis is a rare but potentially devastating side-effect of low molecular weight heparins. These agents are widely used in surgical practice and doctors prescribing them should be aware of the condition, as failure to recognise it may increase morbidity. An unusually severe case is presented with a review of the literature.

Aged↗
PubMed1997

Baby walkers--still a major cause of infant burns.

Baby walkers have been implicated in many forms of paediatric trauma, ranging from finger tip entrapment to severe head injury. Their relationship to childhood burns has been documented previously. The Department of Trade and Industry published further warnings in 1984 and the British Standards Institution in 1989. We wished to determine if the degree or frequency of thermal injury had been lessened by these recommendations. All parents of children under 15 months of age admitted to this unit in 1994 were asked if their child was in a baby walker at the time of injury. Eight of the 32 infants, aged between 6 and 12 months, were burned in their walking aid. Half of the burns were contact and half scalds, and the average in-patient stay was 8 days. One patient required formal resuscitation and three were grafted. The incidence and severity of thermal injury sustained in baby walkers remains at a high level despite increased safety measures. Perhaps it is time to concur with the American Academy of Paediatrics and recommend a ban on these dangerous aids.

Burn Units↗
PubMed1996

The use of pH adjusted lignocaine in controlling operative pain in the day surgery unit: a prospective, randomised trial.

We report the results of a randomised, case matched, controlled, double blind study on 40 patients undergoing correction of their prominent ears, comparing efficacy of pH adjusted lignocaine to lignocaine alone in controlling operative pain. Each patient received commercial lignocaine in one ear and the same preparation reconstituted with 1 ml of 8.4% sodium bicarbonate in the other ear according to our randomisation protocol. 30 patients were studied to compare the difference between the buffered and commercial preparation infiltrated at room temperature. A further 10 patients were studied to assess the benefit the buffered preparation at room temperature had over commercial lignocaine warmed to body temperature. Linear analogue pain scores for discomfort at infiltration and during the operation itself were analysed. Buffered lignocaine imparts a significant reduction in pain on infiltration, compared to the commercial preparation at both room and body temperature. Both preparations were equally effective in obliterating pain during the operation itself.

Adolescent↗
PubMed1996

The problem of bilateral foot reconstruction after severe burns.

Reconstruction of bilateral, distal lower limb defects presents a major reconstructive challenge. In the patient with a major burn injury, however, the problem of bilateral foot reconstruction is compounded by both the limited availability of normal unscarred donor sites and by the limited availability of recipient vessels. A case is presented where bilateral dorsum of foot defects in a patient with a 50% surface area burn were successfully reconstructed using a single parascapular free flap. The problems presented by this case are discussed.

Adult↗
PubMed1996

Asymmetrical cleft palate.

Ten cases of asymmetrical cleft palate are reported. The pathogenesis, classification and management are discussed.

Adolescent↗
PubMed1995

Formal assessment of the surgical trainee: a review of eight years experience at St Lawrence Hospital, Chepstow.

In light of the proposals for a continuum of higher surgical training, we reviewed an 8-year experience of formal assessments of surgical trainees. We undertook a retrospective analysis of 34 completed assessment forms, retrieved from records, and a postal questionnaire of 54 former (and current) trainees. Our study revealed that all trainees agreed in principle with formal assessments. Eighty-one per cent found their assessment either useful or excellent and a further 17 per cent found the advice received was influential in their careers. The consultants, in turn, were able to modify the training programme as a result of constructive feedback. Based on our experience we recommend formal assessments of surgical trainees as an important and rewarding part of an impartial peer review system within a continuum of higher surgical training.

Attitude of Health Personnel↗
PubMed1993

The functional results of hand replantation. The Chepstow experience.

Eight hands amputated at wrist or distal forearm level were replanted between 1983 and 1990. Steinman pins were used to obtain skeletal fixation at the wrist level in three patients. Secondary surgery was performed in seven patients. Six of the patients were available for review between 1.5 and 7.5 years (mean 3.6) after the injury. The functional results were assessed using the Tamai scoring system. Recovery of useful hand function has been achieved in most patients, although long-term recovery of sensibility was found to be disappointing. Despite this finding, five out of the six patients were highly satisfied with the result and four have returned to work.

Adolescent↗
PubMed1990

A critical appraisal of the use of free flaps in primary reconstruction of combined scalp and calvarial cancer defects.

Eleven patients had scalp tumours with full thickness calvarial invasion excised and reconstructed with free flap transfer as a primary procedure. Latissimus dorsi or radial forearm flaps were used, with split rib calvarial reconstruction. One flap was lost peroperatively and another necrosed at 8 days following pedicle compression against an acrylic "skull". Only six patients presently survive, two being treated for recurrence. Long-term follow-up indicates that poor prognostic factors are advanced local invasion, squamous or anaplastic tumours, and advanced age. However, palliative treatment has a role.

Aged↗
PubMed1986

Butylcyanoacrylate adhesives in microvascular surgery: an experimental pilot study.

An investigation was undertaken to examine the effects of the butylcyanoacrylate adhesives (Histoacryl) on vascular tissue. Using a rat femoral artery model, 18 vessels were prepared. End-to-end anastomoses were completed using three stay sutures of 10-0 nylon inserted at 120 degrees intervals around the vessels, followed by direct application of Histoacryl glue. Results showed a patency rate of 73 percent, the vessels being inspected between two and 14 weeks after anastomosis. Histological examination of the vessels showed an early marked foreign body granulomatous response with giant cell formation, and later extreme thinning of the vessel wall, splitting of the elastic lamina, and calcification of the media. It was concluded that the histologic results of butylcyanoacrylate tissue adhesives on the vessel wall preclude their use on human subjects.

Animals↗