Medicine and Health Sciences Commons^™

Treatment Of Rectal War Wounds, O J. Van Waes, J A. Halm, J Vermeulen, Vivian C. Mcalister

Vivian C. McAlister

Treatment strategies for penetrating rectal injuries (PRI) in civilian settings are still not uniformly agreed, in part since high-energy transfer PRI, such as is frequently seen in military settings, are not taken into account. Here, we describe three cases of PRI, treated in a deployed combat environment, and outline the management strategies successfully employed. We also discuss the literature regarding PRI management. Where there is a major soft tissue component, repetitive debridement and vacuum therapy is useful. A loop or end colostomy should be used, depending on the degree of damage to the anal sphincter complex.

Scarpa's Fascia And Clinical Signs: The Role Of The Membranous Superficial Fascia In The Eponymous Clinical Signs Of Retroperitoneal Catastrophe., Shanoor Ullah, Robert Grant, Marjorie Johnson, Vivian C. Mcalister

Vivian C. McAlister

This article deals with the history of membranous superficial fascia (Antonio Scarpa, Abraham Colles), the history of clinical signs that use discoloration of the torso (Cullen's sign, Grey Turner's sign, Fox's sign, Bryant's sign) and then describes anatomical dissection studies to link the two.

INTRODUCTION: The membranous superficial fascia (MSF) was described early in the 19th century, as was its role in the clinical sign of urethral disruption. Clinical signs of haemorrhage or leakage of pancreatic and biliary fluid into the retroperitoneum, which were described throughout the 20th century, all relied on circumscribed discolouration of the skin of the torso. …

Absence Of The Genicular Arterial Anastomosis As Generally Depicted In Textbooks., Maher Sabalbal, Marjorie Johnson, Vivian C. Mcalister

Vivian C. McAlister

This article reviews the history of anatomical research, starting with John Hunter and Astley Cooper, into the arterial anastomosis at the knee and uses dissection to determine the reality. The final draft is available below. (Ann R Coll Surg Engl. 2013 Sep;95(6):405-9)

INTRODUCTION Textbook representations of the genicular arterial anastomosis show a large direct communication between the descending branch of the lateral circumflex femoral artery (DBLCFA) and a genicular branch of the popliteal artery but this is not compatible with clinical experience. The aim of this study was to determine whether the arterial anastomosis at the knee is sufficient, in …

Role Of Persistent Processus Vaginalis In Hydroceles Found In A Tropical Population, Vivian C. Mcalister, Vincent Trottier

Vivian C. McAlister

BACKGROUND:

Lymphatic obstruction by Wuchereria bancrofti is thought to be the mechanism for development of tropical hydrocele in men and for elephantiasis, mostly in women. Hydrocele prevalence is used to determine the effectiveness of para site eradication programs. METHODS:

We maintained a prospective log of operations performed at 1 Canadian Field Hospital during its relief mission to Léogâne, Haiti. Information regarding duration of symptoms, type of previous surgery (if any), surgical approach, associated inguinal hernia and volume and appearance of hydrocele fluid in patients with tropical hydroceles were recorded. RESULTS:

From January to March 2010, 4922 patients were seen, none …

Slow Birth Of New-Wave Medical Journalism, Vivian C. Mcalister

Vivian C. McAlister

Half a century has passed since Sir Theodore Fox reflected upon his recently completed 40-year tenure as editor of The Lancet. He titled his farewell lecture series “Crisis in communication: the functions and future of medical journals.”1 Even though the number of journals had dramatically increased by the 1960s, submissions had proliferated to such an extent that Fox’s principal regret was the increasing fraction he was forced to refuse. In the late 19th century, the surgeon general of the United States was able to catalogue the entire body of medical knowledge up to that time in a volume that would …

Civilian Trauma Care - Learning From The Military Experience, Vivian C. Mcalister

Vivian C. McAlister

In the 21st century, military and civilian trauma surgeons bring similar solutions to similar problems, learning one from another. The objective of this presentation is to review military trauma care in Afghanistan for aspects that may influence civilian practice at home.

• Comprehensive trauma care system: guidelines,

registry, review

• Protocols for care: damage control; massive

blood transfusion policy; mass casualty care

• Techniques: resuscitative thoracotomy;

decompressive craniectomy; pelvic-gluteal

hemorrhage control

• Rehabilitation: Mild traumatic brain injury

• Delegated medical acts: medics / PAs

Grand Rounds: Psoas Abscess With Group B Streptococcus, Adina Feinberg, Vivian C. Mcalister

Vivian C. McAlister

Case Report: A 43-year-old woman presented to the emergency room at University Hospital, London Health Sciences Centre with an eight-day history of lower back pain. She had presented one-week prior with similar symptoms and was treated conservatively for sciatica. Since then, her pain had progressively increased

Indications For Resection Of Metastatic Liver Lesions, Vivian Mcalister

Vivian C. McAlister

No abstract provided.

Pancreatic Cancer: Define Unresectable, Vivian Mcalister

Vivian C. McAlister

No abstract provided.

Causes Of Death In Canadian Forces Members Deployed To Afghanistan And Implications On Tactical Combat Casualty Care Provision., D Pannell, R Brisebois, M Talbot, V Trottier, J Clement, N Garraway, Vivian C. Mcalister, H Tien

Vivian C. McAlister

BACKGROUND: As part of its contribution to the Global War on Terror and North Atlantic Treaty Organization's International Security Assistance Force, the Canadian Forces deployed to Kandahar, Afghanistan, in 2006. We have studied the causes of deaths sustained by the Canadian Forces during the first 28 months of this mission. The purpose of this study was to identify potential areas for improving battlefield trauma care.

METHODS: We analyzed autopsy reports of Canadian soldiers killed in Afghanistan between January 2006 and April 2008. Demographic characteristics, injury data, location of death within the chain of evacuation, and cause of death were determined. …

Drills And Exercises: The Way To Disaster Preparedness, Vivian C. Mcalister

Vivian C. McAlister

Catastrophes, natural or man-made, are very rare events in the life of hospitals in the developed world. None of the hospitals that coped with well known recent events such as Hurricane Katrina or the Madrid bombings had actually experienced or prepared for such an occurrence. A mass casualty incident (MCI), sometimes called “MASCAL,” is a situation in which a hospital receiving multiple casualties does not have the resources to deal with the patients simultaneously. Bottlenecks may occur at any point from the trauma bays to the point of discharge. There are 2 phases in which hospitals fail to cope. In …

“Noted Surgeon, Fine Citizen”: The Life Of Archibald E Malloch, Md 1844–1919 By Charles G. Roland, Chloe Mcalister, Vivian C. Mcalister

Vivian C. McAlister

No abstract provided.

Composite Tissue Allotransplantation To Treat Veterans With Complex Amputation Injuries, Vivian C. Mcalister, Ray Kao, Brian Church, Markus Besemann, Rob Stiegelmar

Vivian C. McAlister

Amputee rehabilitation may be limited by complexity of injury (e.g. bilateral arm amputation), associated injury (e.g. colostomy) or by the level of amputation (e.g. high above knee). Our objective is to assess the potential for composite tissue allotransplantation (CTA) to overcome these barriers. Medical literature was searched and programs were surveyed regarding the current status of CTA. Results CTA remains an experimental reconstructive option that involves a large collaborative (physiatry, orthopaedic, plastic and transplant surgeons). Limb transplantation has evolved out of limb reimplantation surgery and organ transplantation. Approximately 10 programs world wide, with almost a decade of experience, report 90% …

Civilian Versus Military Trauma Management, Vivian C. Mcalister

Vivian C. McAlister

In the 21st century, military and civilian trauma surgeons bring similar solutions to similar problems, learning one from another

Indications For Resection Of Metastatic Liver Lesions, Vivian C. Mcalister

Vivian C. McAlister

No abstract provided.

Pancreatic Cancer: Define Unresectable, Vivian C. Mcalister

Vivian C. McAlister

No abstract provided.

"Body Contouring After Massive Weight Loss," Edited By A. Aly., Vivian C. Mcalister

Vivian C. McAlister

Nowhere is the failure of the health care system, as currently managed, more evident than in the surgical care of obesity. A marked contrast has emerged between surgery in the United States and Canada for these patients. It is not clear whether the reluctance to supply surgical services in Canada is due to a bias in favour of “more deserving” patients or whether the considerably higher rate of obesity surgery in the US is due to the excesses of private enterprise. Governments have acknowledged that an element of the former proposition is true by referring obese patients to centres in …

Demarcated Truncal Jaundice: A Sign Of Retroperitoneal Bile Leakage, Vivian C. Mcalister, Alp Sener

Vivian C. McAlister

The characteristic feature of the clinical sign described here is the demarcation between jaundiced and unaffected areas of the body. The flanks and the genitalia are stained more than would be expected by examination of the sclera or estimation of bilirubin level. Superiorly, a horizontal line about 3 cm below the clavicles, corresponding to the insertion of the fascia of Scarpa into the clavipectoral fascia, allows an easy comparison between the jaundiced trunk and unaffected adjacent areas, such as the neck, shoulder, and arm. Similarly, a line 3 cm below the groin skin crease corresponds to the insertion of the …

Endocrine Surgery: Thyroid, Parathyroid, Adrenal, Vivian C. Mcalister

Vivian C. McAlister

The goal of this seminar is to understand the elements and processes that make up the knowledge required by the curriculum. These questions are designed to take you in a sequential fashion through the topic. By that I mean that the answer of one question will inform the next. Try to answer the questions before you come to the seminar. Use all resources available to you including textbooks, experts and Wikipedia. We will discuss our answers. Remember that our goal is to understand - there is no such thing as a stupid question or a foolish answer. Learning by rote …

Template: History And Physical Examination, Vivian C. Mcalister

Vivian C. McAlister

This simple template contains the headings for a classic history and physical examination report. Clerks and residents on our surgical team are encouraged to use it or a similar system. It is vital to the learning process that you reach a conclusion about a patient's illness and formulate a plan independently. You should verify your findings and care with somebody senior to you on the team.

Harpoon Extraction Of A Common Bile Duct Stone Impacted At The Ampulla Of Vater With Needle-Knife Sphincterotome., Vivian C. Mcalister, Andre Roy, Ron Passi

Vivian C. McAlister

The urgency of dealing with impacted ampullary stones is underlined in the first case reported by Opie6 at the autopsy of a young woman. Impacted ampullary stones that prevent papillary cannulation and standard sphincterotomy make up less than 5% of common bile duct stones seen at ERCP.3 Several series suggest the safe use of needle-knife sphincterotomy to create a choledochoduodenal fistula or to allow subsequent standard sphincterotomy in this situation. These series have also reported failure to extract the stone so that surgical removal was required.3,4Successful sphincterotomy may facilitate the early diagnosis of tumors that cause the ampulla to bulge. …