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Watch Professor Ara Darzi talk through surgical innovations from the past such as laparoscopic surgery, and how innovations in access, quality and cost-effectiveness in the future are important.
This is an unusual presentation of a cutaneous horn in the natal cleft. Epidermal hyperkeratotic activity results in the conical protrusion of compacted keratin. Some 30 per cent of lesions are found on the face and scalp; other common sites include sun-exposed areas such as the chest and shoulder. The horn itself, although benign, can harbour premalignant and malignant epidermal lesions, including squamous and basal cell carcinomas. Associated premalignant and malignant lesions have been reported in up to 51 and 13 per cent of patients respectively. Given the neoplastic potential, formal excision biopsy is recommended.
This 37-year-old woman with end-stage renal disease underwent right-sided brachiocephalic arteriovenous fistula formation 8 years previously. She noticed a swelling in the right elbow region 2 years after the operation, which rapidly increased in size. This is a pseudoaneurysm following right brachiocephalic arteriovenous fistula (AVF). Pseudoaneurysm is a common complication of AVF. It occurs at venepuncture sites that have been overused. Treatment is by resection and restoration of continuity by direct end-to-end anastomosis or by placement of an interposition graft.
This patient had a sebaceous carcinoma. Magnetic resonance imaging showed local infiltration only. He underwent a wide excision with a 2-cm margin including the superficial part of the trapezius muscle, followed by a latissimus dorsi flap reconstruction. Histological examination confirmed sebaceous carcinoma, typical of the Muir–Torre syndrome.
Watch Mr Alberti deliver his presentation on the history of the Journal, which includes fascinating figures and illustrations of the past century.
A 45-year-old woman developed tachycardia and hypotension on day 1 following Roux-en-Y gastric bypass for obesity. On examination, a blue discoloration of the skin was noted in relation to a laparoscopic port site. Anastomotic leak at the enteroenterostomy explained this. During the initial procedure, the integrity of the gastrojejunostomy was assessed using methylene blue dye. At reoperation, an anastomotic leak secondary to staple-line failure at the enteroenterostomy was identified. The blue discoloration of the skin resulted from leakage of the dye at this site and subsequent extravasation through the port site. In addition to the physiological deterioration on day 1, the bright blue ‘bruising’ was a further cutaneous indication of an underlying anastomotic leak.
Journal publishing: Professor Alderson talks through what he describes as the good, the bad and the ugly. His talk covers areas such as peer review, grading research evidence, misconduct in publishing, and qualifications for authorship.
Stoma prolapse is a full-thickness protrusion of intestine through the stoma. Loop stomas have a higher incidence of prolapse than end stomas. Predisposing factors include obesity, increased intra-abdominal pressure, chronic obstructive pulmonary disease, bowel redundancy and weak fascia. Sugar can be sprinkled on the oedematous stoma to reduce the swelling before an attempt at manual reduction. If there is vascular compromise, exploratory laparotomy is mandatory. Surgical revision of the stoma is the treatment of choice.
Sir Muir Gray discusses the first and second healthcare revolutions, and his views on the approaching 'iceberg' of the third healthcare revolution: the increase in need and demand and how to meet those demands.
The magnetic resonance image (MRI) shows an osteochondroma of the proximal tibia. An osteochondroma is a cartilaginous exostosis. In most cases, treatment consists of regular monitoring to identify any changes or complications. a The MRI shows compression of the popliteal vessels (arrow) threatening vascular complications. The tumour can cause damage to the vessel wall resulting in a pseudoaneurysm or occlusion of the popliteal artery. b The osteochondroma was removed surgically using a dorsal approach.
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