Transkei foot

An epidemiological investigation of bone and joint abnormalities in a Xhosa population revealed 6 females with a condition characterised by marked lateral deviation of the fifth toes. This disorder does not seem to have been previously described, and we therefore propose that it should be named 'Transkei foot'. The pathogenesis of the condition is obscure, but it is possible that it has a genetic basis.S. Afr. Med. J. 48, 961 (1974

Tracheostomy reveals a rare aberrant right subclavian artery; a case report

BACKGROUND: Anomalies of vascular anatomy in the neck are well recognised. We present a case of a very rare aberrant artery discovered during tracheostomy. CASE PRESENTATION: Elective tracheostomy was performed in theatre for an elderly gentleman on long-term ventilation. Pre-operative examination of the neck revealed no obvious abnormality. During surgery, a large vessel was revealed overlying the tracheal fourth ring. This was found to be an anomalous right subclavian artery. The procedure was completed without complication. CONCLUSIONS: The vessel abnormality described has not been previously documented in this context. It illustrates the importance of thorough pre-operative assessment of the neck and a sound knowledge of the potential for vascular abnormalities. The increasing prevalence of percutaneous dilatational tracheostomy techniques makes this lesson increasingly relevant

How high do the subclavian arteries ascend into the neck? A population study using magnetic resonance imaging.

BACKGROUND: The relationship between the larynx and the subclavian arteries was studied in a series of magnetic resonance images (MRIs) from 50 patients without neck pathology. METHODS: The vertical distances of the excursion of the subclavian arteries into the neck was measured, as was the distance from the cricoid cartilage to the highest point of this excursion. Statistical analysis allows the probability of any given cricoid-subclavian distance occurring in the population to be estimated. RESULTS: The mean (SD) excursion of the right subclavian artery above the clavicle was 10.4 (11.4) mm. The mean (SD) distance from the cricoid cartilage to the right subclavian artery was 30.6 (14.3) mm, and the data showed a high degree of variance. There was a linear relationship between neck length and cricoid-subclavian distance (r=0.58), which explained some of the variance in the latter, but there was also wide individual variance, which was independent of this regression. CONCLUSIONS: When performing a percutaneous tracheostomy, a 'safe' distance between the incision site and subclavian artery cannot be assumed or reliably predicted from the neck length

Abnormal pupillary activity in a brainstem-dead patient.

The pupils in brainstem-dead patients are classically fixed and dilated. We present a case of a brainstem-dead patient whose pupils displayed persistent asynchronous pupillary constriction and dilatation independent of external physical stimuli. Central causes for the phenomenon were excluded leaving an unexplained peripheral cause as the most likely explanation. Early recognition of this phenomenon prevents delay in the diagnosis of brainstem death, lessening to some extent the distress for the family, and facilitating earlier organ donation and allowing the better use of resources

Sub-Tenon's block reduces both intraoperative and postoperative analgesia requirement in vitreo-retinal surgery under general anaesthesia.

BACKGROUND AND OBJECTIVE: We compared the effects of sub-Tenon's local anaesthetic block and placebo on peri-operative opioid requirement and cardiovascular stability and on postoperative pain, nausea and vomiting in patients undergoing vitreo-retinal surgery under general anaesthesia. METHODS: We studied 43 patients undergoing vitreo-retinal surgery under general anaesthesia in a randomized double blind study. Patients received a standard general anaesthetic followed by a sub-Tenon's injection of 4-5 mL of either bupivacaine 0.75% or saline. We recorded intraoperative invasive arterial pressure, then the incidence and severity of pain and of nausea and vomiting, for 24 h postoperatively. RESULTS: In the sub-Tenon's bupivacaine group, there was a significant reduction in the perioperative opioid use and a reduction in the frequency of bradycardia and hypertensive episodes, defined as a rise > 25% of baseline for a duration of > 3 min. The sub-Tenon's bupivacaine group also had significantly lower pain scores and nausea scores at 12 h, concomitant with a lower consumption of analgesia and antiemetics. CONCLUSIONS: This local anaesthetic technique is effective in vitreo-retinal surgery and can be safely applied to this population of patients regardless of axial length

Motor cortex stimulation for chronic neuropathic pain: a preliminary study of 10 cases.

There is growing evidence to support the use of motor cortex stimulation (MCS) in the management of patients with chronic neuropathic pain. A prospective audit of ten patients using a modified staged technique for motor cortex implantation provides further evidence for the analgesic effectiveness of this technique. Ten patients suffering from phantom limb pain (n=3), post stroke pain (n=5), post traumatic neuralgia secondary to gunshot injury to the brain stem (n=1) and brachyalgia secondary to neuro-fibromatosis (n=150% pain relief) and long-term benefit in 4/5 of patients who initially responded to intermittent cortical stimulation (longest follow up 31 months after implantation). Of those patients who benefited two had post stroke pain, two phantom limb pain and one post-traumatic neuralgia. We conclude that motor cortex stimulation is an effective analgesic intervention in some patients with chronic neuropathic pain, but it is difficult if not impossible to predict those patients who may respond to treatment prior to implantation. Randomised controlled trials are now urgently needed to test the effectiveness of motor cortex stimulation under double-blind conditions