25, 50 and 75 years ago

The development of skills in critical appraisal of the medical literature is an important aspect of surgical training. At the Prince of Wales Hospital, a journal club has been conducted for more than 5 years to improve the registrars' training in this area. A questionnaire was circulated regarding the success of the journal club at achieving adequate review of the important current literature, development of critical appraisal skills by registrars and providing a convivial social gathering. A total of 28 out of 39 current or previous journal club members responded to the questionnaire. Twenty-three of the respondents felt that the journal club provided a good to excellent review of current literature, 26 felt that the journal club facilitated development of critical appraisal skills and all 28 said that the journal club was a convivial social forum. Eight research projects developed from journal club reviews, 19 of the respondents reported that their clinical practice had changed, and 19 had been stimulated to further review a topic as a result of the journal club. Many of the respondents had specific criticisms of the journal club, and these have been used to improve the journal club format. The present study has highlighted the strengths and weaknesses of our journal club. The journal club is a valuable component of surgical education. To evaluate the effectiveness of various scrub techniques in reducing bacterial skin flora, the present study was developed in three stages. Each stage involved fingertip bacterial colony counts measured before, immediately after and 30 min after a variety of handwashing techniques using 10% povidone-iodine solution. The first compared 1, 2 or 3 non-timed washes from fingertips to elbows in 10 volunteers. The second compared two volunteers scrubbing for equal durations with or without friction rubbing, while the third involved 15 volunteers who each scrubbed for different time intervals. The first stage showed that a single wash episode failed to provide lasting bacterial colony count reductions on fingertip cultures. The second showed that enduring colony count reductions occur whether friction rubbing of the hands was used or not, and the third showed that a 30-s wash was as effective as washing for longer periods in reducing fingertip flora. These findings suggest that prolonged vigorous pre-operative scrubbing is unnecessary, although more than a cursory wash is required to produce lasting fingertip antisepsis. Knuckle pads are a frequent finding in patients with Dupuytren's contracture, particularly young patients with a strong Dupuytren's diathesis (Fig. 1). Lesions in the same distribution over the dorsum of the proximal inter- phalangeal joints in particular have been observed in many other patients than those with Dupuytren's contracture, and these patients have been grouped here into those due to occupational frictional trauma (e.g., shearers), post-traumatic reaction of the extensor tendon paratenon or inclusion epithelial cysts, and those with coincidental dermatological lesions predisposed to occur on such traumatically exposed areas. In a prospective study, skin petechice were found in 20 out of 119 patients with fractures. Seven patients with widespread skin petechiae had elevated respiratory rates and hypoxaemia, and five also had cerebral abnormalities. In contrast, the 13 patients with petechice confined to the axillae were well and were not hypoxaemic. The electron microscopic findings suggest that the extravascdar plasma, red cells and fat globules which formed the petechie escaped through gaps between the endothelial cells of postcapillary venules and following rupture of fat-filled capillaries. It is probable that vasoactive amines, thrombocytopenia and hypoxaemia were important factors in the production of these endothelial gaps. When axones have been interrupted, significance is attached to the initial delay, which has been defined as the time between the injury and the entry of the regenerating axones into that portion of the nerve distal to the site of injury. (For the purposes of the paper the time taken for the completion of those muscular changes upon which the restoration of voluntary contraction depends, has also been included.) A method for calculating this delay has been described.