A. Sagi

Early outcome and complications of the extended subcranial approach to the anterior skull base

Objectives: To present the technique of the extended subcranial approach to the anterior skull base and to review the results in 55 patients who underwent the procedure. Study Design: Retrospective review of the records of 55 patients who underwent the extended subcranial approach to the anterior skull base between 1994 and 1998 for the treatment of various neoplasms originating in the nasal cavity, nasopharynx, paranasal sinuses, orbit, or meninges, as well as for the repair of complex craniofacial trauma and/or cerebrospinal fluid (CSF) leak. Preoperative patient evaluation and the surgical technique are also reviewed. Methods: Patient records were retrospectively reviewed and tabulated for age, sex, and indications for procedure, with special focus on early outcome and complications. Results: Twenty‐six patients underwent oncologic resections, 22 patients had reduction of complex fronto‐naso‐orbital and skull base fractures, and seven patients had repair of CSF leak. Significant complications in the oncologic group consisted of one hematoma requiring needle aspiration and two cases of temporary nontension pneumocephalus. In the fracture group, one patient died because of extensive intracerebral damage and multiorgan failure, and one patient had nontension pneumocephalus coupled with CSF leakage and one patient had temporary nontensisn pneumocephalus. The most common late complication in all three groups was anosmia. Conclusions: Based on their review, the authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of various pathological conditions involving the anterior skull base.

Malignant fibrous histiocytoma of soft tissue

SummaryTwo cases of malignant fibrous histiocytoma are presented. The clinicopathologic findings are also reported. The disease was of fast growing pattern and the outcome of one of the cases very rapid. The relative literature is reviewed and the histogenesis is emphasized.

Chemical burns: our 10-year experience.

A review of 173 patients with chemical burns admitted to our burn unit was carried out during the years 1976-85. Most burns were work related (83 per cent). The majority of patients were men aged 21-50 years (mean age = 29.6 years). The mean total body surface area involved was 3.6 per cent (range = 1-30 per cent). The mean length of stay in hospital was 6.3 days (range = 1-52 days). The extremities were involved in 68 per cent of the patients. The more common aetiological agents were bromine and its compounds (36 per cent), then acids (21 per cent), alkalis and organic substances (14.5 per cent each). The severest burns were caused by the inorganic substances. Delayed admission was most characteristic of the bromine and alkali burns. Complications included local infection (19 cases), systemic infection (two cases), inhalation injury (two cases), tissue necrosis (one case) and corneal erosion (one case). There were no deaths. Increased awareness of the hazardous potential of chemicals should help reduce the incidence of chemical burns.

High-pressure water jet injury of the hand

A rare case of high-pressure injection injury to the thumb with water is reported. The problem was managed without surgical exploration despite subsequent involvement of the small finger.

Transdermal Scopolamine Use for Postrhytidectomtomy Sialocele

BackgroundPostrhydectomy sialocele is a rare complication. The usual treatment uses prolonged drainage. The use of antisialogogues has been described previously, but has potential side effects. Transdermal scopolamine SCOPODERM TTS is indicated for the prevention of motion sickness and also has antisialogugue action.MethodsAn interventional case report is presented.ResultsThe application of transdermal scopolamine SCOPODERM TTS resulted in resolution of a postrhydectomy sialocele within 6 days.ConclusionTransdermal scopolamine delivery should be considered as an option for the treatment of postrhidectomy parotid fistulas.

Burn hazard from cupping—an ancient universal medication still in practice

The ancient universal medication of cupping is still practised by devoted believers and people who, for various reasons, have lost faith in other more modern modalities of medical treatment. Faulty technique in producing the vacuum in the cups was the aetiology of the burns in several patients. The history, theories and indications for cupping are reviewed.

Burns caused by bromine and some of its compounds

Our experience with infrequent and unfamiliar types of injury caused by various compounds of bromine are described and discussed. While bromine containing compounds share some of the characteristics of other common causes of chemical burns, they also have a specific, exclusive mode of affecting the skin. The delay in the appearance of clinical signs and symptoms is an important factor to be considered by those who treat injuries caused by bromine or some of its compounds, or by those who may be the first to see persons who are injured by these agents. As most of the injuries occur at work (92 per cent) it is in these industrial premises that considerable stress should be made of the importance of wearing protective clothing in order to reduce local damage and prevent systemic effects. Prompt first aid, by thorough washing with large volumes of water reduces the extent and depth of the injury.

Jellyfish envenomation: a summer epidemic

During the summer of 1987 the shores of Israel were infested by waves of jellyfish. Thirty patients, mainly children, suffering various degrees of painful injuries to different parts of their bodies were treated in our emergency ward. A typical case is reported and the appropriate treatment recommended.

‘The fire coral’ (Millepora dichotoma) as a cause of burns: A case report

A case of a full skin thickness burn after contact with a Hydrozoa, Millepora dichotoma, is described. The poison secreted by specialized cells on the spines of this marine animal is a strong local irritant. Deep burns due to this agent do not appear to have been described before.

Bilateral hip resection for closure of trochanteric pressure sores: case report

Bilateral resection of the proximal femur, an orthopaedic procedure advocated in selected cases of infected hip joints, can be useful in the treatment of extensive pressure sores in paraplegics. It is especially indicated in those cases where a total thigh flap is considered with the advantage of saving the limb, and by shortening the leg providing more skin and soft tissue for closure of the pressure sores.