Arul GS, Carroll S, Kyle PM, Soothill PW, Spicer RD. Intestinal complications associated with twin-twin transfusion syndrome after antenatal laser treatment: Report of two cases. J Pediatr Surg. 2001, 36: 301–2. Chang YL. Fetoscopic laser therapy for twin-twin transfusion syndrome. Taiwan J Obstet Gynecol. 2006, 45: 294–301. Karunaratne S, Mukherjee S, Ramanan R. Laser therapy for twin-to-twin transfusion syndrome causing amniotic band syndrome. Arch Dis Child Fetal Neonatal Ed. 2011, 96: F35. Schrey S, Huber A, Hecher K et al. Vascular limb occlusion in twin-twin transfusion syndrome (TTTS): case series and literature review. Am J Obstet Gynecol. 2012, 207: 131.e1–10.

Although the incidence of glass injury following road traffic accidents has been decreasing over the past five decades, the location and source of glass bodies from accidents involving vehicles can prove difficult for the radiologist and surgeon and in medico-legal disputes. This case illustrates the issues with regard to penetrating injuries from different types of glass used in the automotive industry. Shatterproof glass windscreens with a laminated coating have been developed to prevent fragmentation and dispersal. This has led to a significant reduction in glass-related injury. Although laminated glass fitted in front windscreens and in some side windows is designed not to shatter, fragmentation can indeed take place in cases of high impact, resulting in penetrating injury that can be difficult to detect and can lead to injury and morbidity. The attending clinician should therefore consider penetrating injuries in the clinical and radiological assessment of individuals who present after motor vehicle accidents and be aware that laminated glass, although considered to be "safe", can indeed be responsible for penetrating injury. We present a unique case report to illustrate this important point, which may encourage debate in the medical world and motor manufacturing industry.

Non-Hodgkin's lymphoma usually presents with lymphadenopathy at multiple sites but can also involve any part of the musculoskeletal system. Occasionally the presentation is with a soft tissue mass. The presentation of large, superficial lymphomatous masses is similar both clinically and radiologically to that of soft tissue sarcomas. The six cases of lymphoma presenting to the Exeter Sarcoma Service as suspected soft tissue sarcomas, over a two-year period (2002-2004), are presented. We describe the clinical and imaging characteristics of these tumours and their subsequent management. Our cases showed variability in presentation. Only one of the six cases presented with pain and one with tenderness. Four of the cases had no lymphadenopathy and the other two had lymphadenopathy restricted to one nodal basin. Overlying soft tissue swelling occurred in four cases and in distal limb swelling beyond the mass in one case. Radiologically, lymphomas are known to be likely to exhibit confluent lymphadenopathy that is rare in patients with soft tissue sarcoma. Confluent lymphadenopathy was demonstrated in only one case of this series of patients. It is thought that lymphomas infiltrate across anatomical fascial planes more readily than sarcomas and in four of our six cases this feature was present. Clinical history, examination and MRI are insufficient to differentiate between soft tissue sarcoma and lymphoma and the importance of obtaining a pathological diagnosis prior to surgery is clear. It is crucial to differentiate lymphoma from sarcoma in order to avoid unnecessary excisional procedures in lymphoma patients.

We present two cases of solitary fibrous tumour (SFT) showing biphasic morphology with a spectrum of malignant epithelioid components. Slides prepared from formalin-fixed and paraffin-embedded tissue from both cases were stained with haematoxylin and eosin and by immunohistochemistry. Interphase fluorescent in situ hybridisation studies were performed in both cases using paraffin-embedded tissue to look for the t(X;18) translocation, thereby to exclude synovial sarcoma. Both cases showed biphasic morphology with some areas having typical benign spindled SFT morphology (including CD34 expression) and other areas having a malignant epithelioid appearance. In one of the cases, the epithelioid area, which was well circumscribed and showed packeting of cell groups, demonstrated expression of cytokeratin and epithelial cadherin but not of CD34. In the second case, the immunophenotype of the epithelioid component was similar to that of the benign SFT component. These findings suggest that epithelioid change in SFT shows a range of differentiation at one end, similar to that of a standard SFT, and at the other end, possibly acquiring epithelial characteristics.

Well differentiated liposarcoma (atypical lipomatous tumour) is a low grade tumour, with no metastatic potential unless dedifferentiation supervenes. When superficial, it recurs locally only occasionally after marginal excision. We present a patient in whom bilateral childhood retinoblastoma was followed by later development of massive confluent areas of low grade liposarcoma and lipomatous tissue affecting the upper extremities and trunk. We discuss the role of mutations in the retinoblastoma gene (RB1) in linking these conditions and demonstrate the surgical management of an extremely unusual and challenging case.

Soft tissue sarcomas are investigated by magnetic resonance imaging (MRI) both for initial staging and follow-up. We describe the presence of increased signal on T2-weighted images caused by a neurotized muscle flap following reconstructive surgery. This raised concern about possible sarcoma recurrence that was not clinically evident. On post-operative imaging of sarcomas the presence of recurrent tumour is indicated by a mass and high signal intensity on T2-weighted images. However, high signal changes in skeletal muscle on T2-weighted images are not specific. In this case, the free functioning muscle transfer with neurotization of the flap mimicked recurrence on MR scan. High signal intensity on T2-weighted images in muscle is an indication of either a physiological change or a pathological condition and must be taken in context of the clinical picture.

Homeopathic arnica is widely believed to control bruising, reduce swelling and promote recovery after local trauma; many patients therefore take it perioperatively. To determine whether this treatment has any effect, we conducted a double-blind, placebo-controlled, randomized trial with three parallel arms. 64 adults undergoing elective surgery for carpal tunnel syndrome were randomized to take three tablets daily of homeopathic arnica 30C or 6C or placebo for seven days before surgery and fourteen days after surgery. Primary outcome measures were pain (short form McGill Pain Questionnaire) and bruising (colour separation analysis) at four days after surgery. Secondary outcome measures were swelling (wrist circumference) and use of analgesic medication (patient diary). 62 patients could be included in the intention-to-treat analysis. There were no group differences on the primary outcome measures of pain ( P=0.79) and bruising ( P=0.45) at day four. Swelling and use of analgesic medication also did not differ between arnica and placebo groups. Adverse events were reported by 2 patients in the arnica 6C group, 3 in the placebo group and 4 in the arnica 30C group. The results of this trial do not suggest that homeopathic arnica has an advantage over placebo in reducing postoperative pain, bruising and swelling in patients undergoing elective hand surgery.

This contribution introduces an unreported technique of ultrasound-guided steroid injection, for osteoarthritis of the trapeziometacarpal joint.

Focus on Alternative and Complementary TherapiesVolume 7, Issue 1 p. 110-110 Homoeopathic arnica for postoperative complications: randomised placebo-controlled trial C Stevinson, C Stevinson Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this authorVS Devaraj, VS Devaraj Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this authorA Fountain-Barber, A Fountain-Barber Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this authorS Hawkins, S Hawkins Department of Plastic and Reconstructive Surgery, Royal Devon and Exeter Hospital, UKSearch for more papers by this authorE Ernst, E Ernst Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this author C Stevinson, C Stevinson Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this authorVS Devaraj, VS Devaraj Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this authorA Fountain-Barber, A Fountain-Barber Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this authorS Hawkins, S Hawkins Department of Plastic and Reconstructive Surgery, Royal Devon and Exeter Hospital, UKSearch for more papers by this authorE Ernst, E Ernst Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this author First published: 14 June 2010 https://doi.org/10.1111/j.2042-7166.2002.tb03396.xRead the full textAbout ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume7, Issue1March 2002Pages 110-110 RelatedInformation

A case of isolated thenar wasting caused by a large superficial palmar branch of the radial artery is reported.

Fifty-eight patients with the diagnosis of primary frozen shoulder were independently examined by 3 surgeons for evidence of Dupuytren's disease. The disease was found in 52% (30/58) of the patients reviewed. These figures were compared with previously reported figures for a population of similar age. This showed that Dupuytren's disease is 8.27 (95% CI, 6.25-11.2) times more common in patients with frozen shoulder than in the general population; the difference between the two was highly statistically significant (P < .001, chi(2) test). We discuss the literature on the association between frozen shoulder and Dupuytren's disease and the implications of such a high proportion of patients sharing these two conditions.

Chitosan is a derivative of chitin, extracted from the exoskeleton of lobsters, crabs and shrimps. As a semi-permeable biological dressing, it maintains a sterile wound exudate beneath a dry scab, preventing dehydration and contamination of the wound to optimise conditions for healing. In this study, evaluation of healing at split skin graft donor sites, dressed half with chitosan and half with a conventional dressing, showed that chitosan facilitated rapid wound re-epithelialisation and the regeneration of nerves within a vascular dermis. In addition, digital colour separation analysis of donor site scars demonstrated an earlier return to normal skin colour at chitosan-treated areas.

Outpatient non-attendance is a common source of inefficiency in a health service, wasting time and resources and potentially lengthening waiting lists. A prospective audit of plastic surgery outpatient clinics was conducted during the six months from January to June 1997, to determine the clinical and demographic profile of non-attenders. Of 6095 appointments 16% were not kept. Using the demographic information, we changed our follow-up guidelines to reflect risk factors for multiple non-attendances, and a self-referral clinic was introduced to replace routine follow-up for high risk non-attenders. After these changes, a second audit in the same six months of 1998 revealed a non-attendance rate of 11%--i.e. 30% lower than before. Many follow-up appointments are sent inappropriately to patients who do not want further attention. This study, indicating how risk factor analysis can identify a group of patients who are unlikely to attend again after one missed appointment, may be a useful model for the reduction of outpatient non-attendance in other specialties.

Soft tissue calcification may be an unspecific local response or cause pain and present as part of a complex underlying disease. It can be exquisitely painful when located in the pulp of the digits. In this paper we describe a new minimally invasive technique for the treatment of finger calcinosis in patients with CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal hypomotility, sclerodactyly, telengectasia). A rose head or micropoint burr on a minidriver or microaire system is used to disrupt the calcific deposit. Healing is usually rapid.