The Antenatal Diagnosis of Cephalothoracopagus Janiceps Conjoined Twins

Summary: A case of cephalothoracopagus conjoined twins (Janiceps twins) is presented. The abnormality was detected antenatally by the use of ultrasonography and confirmed postnatally, clinically and by computed tomography (CT scan).     

Lessons Learned from Laparoscopic Gastric Banding

The Author reviews 27 laparoscopic gastric banding operations, of which 19 cases were completed. Of the 27 operations, eight were revisions of earlier laparoscopic banding. The lessons learned from these cases are highlighted.     

A Population-Based Study of Pancreatic Trauma in Scotland

Introduction The aim of this population-based study was to assess the incidence, mechanisms, management and outcome of patients who sustained pancreatic trauma in Scotland over the period 1992–2002. Methods The Scottish Trauma Audit Group database was searched for details of any patient with pancreatic trauma. Results About 111 of 52,676 patients (0.21%) were identified as having sustained pancreatic trauma. The male-to-female ratio was 3:1, with a median age of 32 years. Blunt trauma accounted for 66% of injuries. Road traffic accidents were the most common mechanism of injury (44%), followed by assaults (35%). Thirty-four patients (31%) were haemodynamically unstable on arrival at hospital. Pancreatic trauma was associated with injuries to the chest (56%), head (30%) and extremities (30%); 73% of patients had other intra-abdominal injuries. Of those who left the emergency department alive, at least 77% required a laparotomy. The mortality rate (46%) was directly proportional to the number of injuries sustained (P < 0.05) and was higher in patients with increasing age (P < 0.05), haemodynamic instability (P < 0.05) and blunt trauma (P < 0.05). Conclusions Pancreatic trauma is rare in Scotland but is associated with significant mortality. Outcome was worse in patients with advanced age, haemodynamic instability, blunt trauma and multiple injuries. All work done in Edinburgh, Scotland, UK.     

Minimally Invasive, Radioguided Surgery for Primary Hyperparathyroidism

Background: Primary hyperparathyroidism affects 1 in 700 individuals in the United States. A single adenoma is responsible in over 85% of cases. Surgery remains the most effective treatment. This study was designed to assess the feasibility of minimally invasive radioguided parathyroidectomy MIRP with confirmation of excision by ex vivo radioactivity alone.Methods: Seventy-five consecutive patients with primary hyperparathyroidism were prospectively studied. Following sestamibi scan, patients underwent unilateral neck exploration guided by a handheld gamma probe, which was also used to measure ex vivo radioactivity of excised tissue.Results: The sestamibi scan was positive in 88% of the patients. A small incision mean, 3.2 ± 0.3 cm was sufficient. Ectopic gland sites were localized in five patients with positive scans and single adenomas. Mean operative time was 48 minutes range, 15–125 minutes, with shorter procedures after the initial 20 cases mean, 24 vs. 72 minutes; P < .01. Radioguided parathyroidectomy was successful in 97%, with a mean follow-up of 11 months range, 1–26 months. As noted previously, adenomatous parathyroid glands contained more than 20% of the background radioactivity.Conclusions: MIRP is a feasible alternative to bilateral dissection with the advantages of guided dissection and rapid confirmation, and may become the procedure of choice for primary hyperparathyroidism.