Survival outcome was significantly better in the screened vs the symptomatic population in all groups and also in those treated for curative intent. There was a trend towards better survival for screen detected cancer when compared stage for stage.

INTRODUCTION Blunt abdominal trauma (BAT) is a common injury in recent trauma series. The characteristics of patients with BAT have changed following the reconfiguration of UK trauma services. The aim of this study was to build a new profile for BAT patients undergoing immediate or delayed laparotomy. METHODS All 5,401 consecutive adults presenting with major trauma between April 2012 and April 2014 in the 3 major trauma centres in the West Midlands were analysed to identify all patients with BAT. A total of 2,793 patients with a mechanism of injury or symptomatology consistent with BAT were identified (52%). Outcomes were analysed using local electronic clinical results systems and notes. RESULTS Of the 2,793 patients, 179 (6.4%) had a mesenteric or hollow viscus injury, 168 (6.0%) had a hepatobiliary injury, 149 (5.4%) had a splenic injury and 46 (1.6%) had a vascular injury. Overall, 103 patients (3.7%) underwent an early (<12 hours) laparotomy while 30 (1.1%) underwent a delayed (>12 hours) laparotomy. Twenty (66.7%) of those undergoing a delayed laparotomy had a hollow viscus injury. In total, 170 deaths occurred among the BAT patients (6.1%). In the early laparotomy group, 53 patients died (51.5%) whereas in the delayed laparotomy group, 6 patients died (20.0%). CONCLUSIONS This series has attempted to provide the characteristics of patients with BAT in a large contemporary UK cohort. BAT was found to be a common type of injury. Early and delayed laparotomy occurred in 3.7% and 1.1% of these patients respectively, mostly because of hollow viscus injury in both cases. Outcomes were comparable with those in the international literature from regions with mature trauma services.

SummaryClassical supraclavicular brachial plexus block was used as the sole anaesthetic technique in 200 children aged between 5 and 12 years undergoing closed reduction of arm fractures. The local anaesthetic used was lidocaine 1.5% with epinephrine. The block was graded as satisfactory if surgical manipulation could be performed without discomfort and unsatisfactory if general anaesthesia had to be given. In 182 children, the procedure was carried out under the block alone, whereas the remaining 18 patients required general anaesthesia. The mean (SD) time required for performing the block was 9.1 (3.7) min and the mean (SD) time to sensory blockade was 8.3 (2.3) min. The mean duration of analgesia was < 3.5 h. There were few complications, with no incidence of pneumothorax in any patient. The acceptability of the block by the children and the parents was 72 and 85%, respectively. The classical supraclavicular brachial plexus block was found to be acceptable, effective and with a good success rate.Keywords Anaesthetic techniques: regional; brachial plexus. Surgery: orthopaedic. Anaesthesia: paediatric. Brachial plexus block is often used to provide anaesthesia for closed reduction of fractures of the upper extremity [1]. Reports confirm that the supraclavicular approach is easy to perform [2] and provides reliable anaesthesia of the upper extremity with excellent muscular relaxation [3, 4]. However, there do not appear to be any reports of the use of classical supraclavicular block [5, 6] in children in the recent past.In our institution, which is situated in the eastern hills of Nepal, we encounter a large number of children with supracondylar fractures of the upper extremity. Most of these children sustain fractures as a result of falling from a height, usually from trees. As they are treated on a day-care basis, we designed a prospective study of the feasibility of using classical supraclavicular brachial plexus block as the sole anaesthetic technique. In this clinical study, we evaluated the acceptability, simplicity, safety and effectiveness of supraclavicular block in young children with upper extremity trauma. MethodsThis prospective study was undertaken in 200 ASA physical status I and II children aged between 5 and 12 years who were scheduled to undergo closed reduction of upper extremity fractures on a day-care basis. Approval of the hospital's ethics committee was obtained as was informed consent from each patient and his or her parents. The procedure was explained in detail to the children and their parents, who were present in the operating theatre during the insertion of the block. All blocks were performed or supervised by the authors. Patients with an open wound or with possible infection at the site of injection, those with associated multiple injuries and those requiring open procedures were not studied. The children were kept fasting for solids for 4 h and for clear liquids for 2 h and were premedicated with oral diazepam 0.2 mg.kg 21 1 h before the procedure. No other sedation was given du...

In the last six years, anterior mandibulotomy was used to approach tumours of the oropharynx and oral cavity in 39 cases. Twenty-six of these had primary lesions in the anterior two-thirds of the tongue. Eight cases had lesions in the base tongue, three in the cheek, and two in the tonsil. Twenty-six cases had T3 tumours, nine had T2 lesions, and four had T4 tumours. Twenty-five patients received post-operative radiotherapy. In 16 cases the mandibulotomy was combined with a marginal mandibulectomy. In 23 cases reconstruction was carried out using a pectoralis major myocutaneous flap. Adequate margins on histopathology obtained in all but eight patients. Bone-related complications occurred in only three patients, all of whom were previously irradiated. Thus the anterior mandibulotomy provides excellent exposure for oral and oropharyngeal tumours, with low complication rate, and avoidance of segmental mandibulectomy.

Intraperitoneal techniques of LA during LC decrease postoperative pain and shorten time in theatre recovery. Injection of LA to the right hemidiaphragm is associated with lower pain scores for a longer period following LC than a previously validated wash technique.