Livingstone Community Hospital

Patients with advanced gastrointestinal cancer develop many symptoms as the disease progresses. However, the common problems of pain, nausea and vomiting, anorexia, constipation and intestinal obstruction can all be relieved by appropriate pharmacological treatment.Eur J Gastroenterol Hepatol12:375-379 © 2000 Lippincott Williams & Wilkins European Journal of Gastroenterology & Hepatology 2000, 12:375-379

This is a case report of the palliative care management of a 13-year-old girl who died of juvenile onset Huntington's disease in a children's hospice in the southeast of England. It outlines her disease progression and describes the care that she received. In particular, the medications and other measures used to control her symptoms during her last 10 days are discussed. The article also explores some of the ethical difficulties of caring for children dying from degenerative disorders. Although juvenile onset Huntington's disease is an extremely rare condition, the issues around terminal care management are very similar to those for any neuro-degenerative disorder, whether in an adult or child. A number of children's hospices have opened in the last 10-15 years in the UK. They accept children with a wide range of life-limiting conditions and have become experts in offering respite care and symptom control to these children and their families. They are chosen increasingly as the place of death for such children.

Primary ventral and even small incisional hernias have historically been repaired by primary closure; however, data proves that use of mesh can significantly reduce hernia recurrence. Here we report clinical outcomes at one year using the International Hernia Mesh Registry following the use of a three-dimensional tissue-separating mesh device (Proceed Ventral Patch™, Ethicon, Somerville, NJ). This ongoing prospective multi-center registry collects preoperative, perioperative, and postoperative outcome data including adverse events at 1, 6, 12, and 24 months. Patient-reported outcomes are collected including a hernia-specific questionnaire. A total of 234 patients (72.1% male, 27.9% female) from 13 sites in the United States and Europe were enrolled. Mean age and BMI were 52.2 (SD 15.0) and 29.2 kg/m² (SD 5.2), respectively. Hernia types: umbilical 67.1%, epigastric 11.5%, small incisional including trocar 21.3%. Preoperatively 46.9% and 38.3% of patients reported symptomatic pain and movement scores, respectively. At 1 year, these were significantly reduced to 8.9% and 5.0%, respectively (p < 0.001). At 12 months hernia recurrence was 3.0% (95% CI, 1.2% to 6.1%), seroma (2.1%), infection (2.1%) with other events being less than 1%. These results indicate repair using this device led to significant improvement in pain and movement limitations and were associated with low complication and recurrence rates.

1985 House of Lords ruling in Gillick v DHSS, which still holds good today, may serve to remind doctors of the duty they owe to parents and to their profession.Lord Justice Fraser: "Nobody doubts that in the overwhelming majority of cases the best judges of a child's welfare are his or her parents.Nor do I doubt that any important medical treatment of a child under 16 would normally only be carried out with the parent's approval.That is why it would and should be 'most unusual' for a doctor to advise a child without the knowledge and consent of the parents on contraceptive matters."Lord Justice Scarman: "I accept that great responsibilities will lie on the medical profession.It is however a learned and highly trained profes- sion, regulated by statute and governed by a strict ethical code which is vigorously enforced.Abuse of the power to prescribe contraceptive treatment for girls under the age of 16 would render a doctor liable to severe professional penalty."

A painful soft tissue mass of the plantar aspect of both feet, in a 5-year-old child, is presented. Plantar incisions are ideal in specific cases as long as the surgeon adheres to certain principles, as outlined in this manuscript. A discussion of lipomas is also presented. Optimum exposure is the key to total eradication of soft tissue lesions and to proper maintenance of wound healing. Location of the lesion presented warranted use of the plantar approach. Minimal hypertrophy of the plantar scar was achieved, as well as few symptoms by the patient.