Biomedical subjects
Publications and source records attributed to P Jervis.
Devolution will bring health policy under the democratic control of the directly elected Scottish parliament and Welsh assembly. Some fear that members of these bodies may wish to interfere in service delivery, rather than concentrating on strategy. Devolution could highlight anomalies in health spending. Many professionals fear that devolution will fragment UK-wide policy networks.
This article describes a surgical technique for the treatment of chronic stenosing otitis externa. A retrospective survey of the post-operative course in eight patients (10 ears) showed this to be a satisfactory treatment with no recurrence of symptoms.
We report two cases of facial haematoma following streptokinase therapy. This is an important complication as it can have fatal consequences. Early recognition and close monitoring are essential as emergency intervention may be required.
Laparoscopic techniques have revolutionised the surgical approach to cholecystectomy, even though there have been no published randomised controlled trials to demonstrate the safety of this approach. We present an audit of 555 patients offered laparoscopic cholecystectomy. In all, 54 patients (9.7%) were converted to an open procedure. Peroperative cholangiography (POC) was attempted in 190 cases (34.2%) and achieved in 141 (25.4%). Major complications occurred in 26 cases (4.7%) including 5 (0.9%) deaths, two of whom had major pre-existing morbidity. There was one common bile duct (CBD) injury (0.18%). There were 30 patients (5.4%) found to have CBD stones, 27 of which were cleared at ERCP, and three converted to open exploration. Cholecystectomy by any route is a major operation and we conclude that careful case selection remains imperative. However, morbidity is favourable compared with open cholecystectomy, and comparable with other reports using the laparoscopic technique. Our experience of CBD injury (0.18%) is also acceptable compared with the risk of injury during open cholecystectomy. There were 312 patients (56.2%) who did not undergo perioperative CBD imaging with ERCP or POC and three of these developed early symptomatic retained stones. This group requires further follow-up.