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ABSTRACT: Venous congestion in a free TRAM or DIEP flap when the main pedicle is still patent (both the artery and the vein) is an occasional dire situation. Here, we describe ways of salvaging the free TRAM or DIEP flap from imminent loss. In the last 4 years, we have had three patients who developed venous congestion after the use of the TRAM or DIEP flap for breast reconstruction. This was detected as late as the third postoperative day in our first patient. On exploration, patent arterial and venous anastomoses were found. Fortunately, the opposite pedicle had been dissected and preserved with the flap. The patent congested vein in this pedicle was anastomosed to the cephalic vein using an interpositional vein graft, relieving the congestion. In the other two patients congestion was detected earlier and relieved using the superficial inferior epigastric vein. It has been our policy to dissect a length of the opposite pedicle and/or preserve a length of the superficial inferior epigastric vein or the superficial circumflex iliac vein. These can then be used to augment venous drainage if inadequacy is noted at the end of the operation or during the postoperative period.
British Journal of Plastic Surgery 07/2001; 54(4):335-7. · 1.29 Impact Factor
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ABSTRACT: One hundred and fifty unselected elderly community subjects were assessed by Mini-Mental State Examination (MMSE), Abbreviated Mental Test (AMT) and Mental Status Questionnaire (MSQ). The effects on cognitive test scores of potential confounding (non-cognitive) variables were evaluated. Sensitivities and specificities were: MMSE 80% and 98%; AMT 77% and 90%; and MSQ 70% and 89%. The MMSE identified significantly fewer false positives than the AMT and MSQ. The major effect of intelligence on cognitive test scores has previously been underestimated. Age, social class, sensitivity of hearing and history of stroke were also significantly correlated with cognitive test scores. Years of full time education and depression only affected the longer MMSE and CAMCOG. The MMSE (cut-off 20/21) can be recommended for routine screening. However, as scores are affected by variables other than cognitive function, particularly intelligence, further assessment of identified cases may fail to reveal significant functional impairment.
Psychological Medicine 04/1996; 26(2):427-30. · 6.16 Impact Factor
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ABSTRACT: Ten healthy volunteers were examined with single photon emission tomography and 99mTc-exametazime. They were studied on 2 occasions, during a 2- and a 3-sound auditory discrimination (oddball) task. Twenty healthy volunteers were used as controls, studied once at rest. During the 2-tone task there was a bilateral posterior (occipito-) temporal and medial frontal activation, a left pericentral increase, and posterior cingulate suppression. During the 3-sound task activation was again found in posterior (occipito-) temporal, medial frontal cortex, left pericentral, with a small non-significant reduction in posterior cingulate uptake. Compared with the 2-tone task, there was a trend towards higher activity in left medial frontal, right posterior temporal and posterior cingulate cortex in the 3-sound task. P3b amplitudes were negatively correlated with posterior cingulate tracer uptake during both tasks. Positive correlations with P3b amplitudes were found in various frontal and temporal regions. These results are consistent with more invasive localisation studies of P3b. Posterior cingulate cortex appears to be inhibited during the oddball tasks, the more so, the more restricted the range of stimuli, and the greater the task-related recruitment of neurones (P3b amplitude). As expected from its more frontal distribution, P3a amplitude was positively correlated with anterior cingulate tracer uptake, and negatively correlated with temporal cortical activity.
Electroencephalography and Clinical Neurophysiology 01/1996; 95(6):434-43.
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ABSTRACT: The Cognitive Estimation Test (CET) was devised in an attempt to quantify the tendency observed in patients with frontal lobe lesions to produce bizarre estimations in response to fairly simple questions, despite performing normally on standard intelligence tests. Several studies have been published where CET performance in patient groups has been examined. However, there is a paucity of adequate normative data. In the present study, representative normative data are provided from 150 healthy controls. CET performance was found to be moderately related to general intellectual ability, with females performing more poorly than males. The scale was examined psychometrically, and was found to be factorially impure, with poor internal reliability but adequate inter-rater reliability. Further revision of the CET is required in order to render it a psychometrically acceptable instrument.
British Journal of Clinical Psychology 06/1994; 33 ( Pt 2):193-7. · 1.90 Impact Factor
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ABSTRACT: Patients attending the Royal Edinburgh Hospital emergency psychiatric clinic over a four month period were assessed by semi-structured interview. General Practitioner and self-referrals were compared with respect to presenting features and subsequent management. Self-referral was associated with young age, male sex, unemployment, poor social cohesion, problem drinking, a forensic history, and mild levels of psychiatric disorder. Only 10% of self-referrals were considered appropriate psychiatric emergencies, but 69% of General Practitioner referrals. Five per cent of self- and 34% of General Practitioner-referrals were admitted. These findings indicate that if the psychiatric emergency clinic is to be of benefit to those it serves, it must not confine itself simply to assessment of mental disorder, but seek to facilitate crisis resolution.
Health bulletin 04/1993; 51(2):67-71.
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British journal of experimental pathology 04/1947; 28(2):141-52.
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Canadian journal of public health. Revue canadienne de santé publique 03/1947; 38(3):141-8. · 1.02 Impact Factor
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British medical journal 06/1946; 1(4457):865-70.
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British medical journal 06/1946; 1:865-70.
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ABSTRACT: Ten healthy volunteers were examined with single photon emission tomography and 99mTc-exametazime. They were studied on 2 occasions, during a 2- and a 3-sound auditory discrimination (oddball) task. Twenty healthy volunteers were used as controls, studied once at rest. During the 2-tone task there was a bilateral posterior (occipito-) temporal and medial frontal activation, a left pericentral increase, and posterior cingulate suppression. During the 3-sound task activation was again found in posterior (occipito-) temporal, medial frontal cortex, left pericentral, with a small non-significant reduction in posterior cingulate uptake. Compared with the 2-tone task, there was a trend towards higher activity in left medial frontal, right posterior temporal and posterior cingulate cortex in the 3-sound task. P3b amplitudes were negatively correlated with posterior cingulate tracer uptake during both tasks. Positive correlations with P3b amplitudes were found in various frontal and temporal regions. These results are consistent with more invasive localisation studies of P3b. Posterior cingulate cortex appears to be inhibited during the oddball tasks, the more so, the more restricted the range of stimuli, and the greater the task-related recruitment of neurones (P3b amplitude). As expected from its more frontal distribution, P3a amplitude was positively correlated with anterior cingulate tracer uptake, and negatively correlated with temporal cortical activity.
Electroencephalography and Clinical Neurophysiology.
