266
Comment
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Transcholecystic operative cholangiography: an alternative technique
In response to the comments I made regarding the Gourevitch metal cannula for use during peroperative cholangiography (Annals, January 1991, vol 73, p43), I have received numerous requests for further information and in particular relating to the manufacturer as well as to its inventor.
o.e..
..;am ._iB
Figure 1.
The standard cannula is based on a 19G needle (Fig. 1) and is quite malleable. Since it is made of metal it can be autoclaved repeatedly and has a very long life span. The cannula can also be provided to varying specifications and is manufactured on request. The standard cannula has a connection piece suitable for most extension tubings in routine clinical use. They are available as a minimal order of ten cannulas (total cost £27.50) from: Steriseal Sales Department Thornhill Road Redditch West Midlands B98 9NL Tel: 0527 64222
....g....r
:~~~~~~~~~~~~~~~~~~~~~~~~~~............
The cannula was popularised by Arnold Gourevitch (Fig. 2), Consultant Surgeon at the Queen Elizabeth Hospital, Birmingham. The idea to develop the cannula came to him during a visit to Denmark in the 1960s when he was shown a cannula by one of the surgeons he met. He felt he could improve upon the design and asked a local firm to start producing it. Although it is used throughout the West Midlands it is curious that it does not seem to have become more widely adopted. Those who knew Arnold Gourevitch (he retired in 1979) will tell you the likely reason, for he had a quality which often accompanies that rare breed of a truly inventive master surgeon, namely utmost humility and an aversion to publicity. He also was, and remains, a very kind man, a fact of some relevance to the messenger! J P NEOPrOLEMOS MA MD FRCS Reader in Surgery Dudley Road Hospital Birmingham
Deaths following trauma: an audit of performance I read the above article (Annals, January 1991, vol 73, pS3) with
particular interest in view of the current efforts to improve trauma management. However, the overriding conclusion, which I made from the experience of Leicester Royal Infirmary, is that an improvement is required in the management of head injuries. This does not seem to have been particularly emphasised by the authors. There was only one preventable death from non-CNS injury among the patients under the age of 55 years as against 11 preventable deaths from CNS injury. While there were more deaths from non-CNS injuries among the patients over the age of 54 years, this group is obviously more difficult to treat with pre-existing medical conditions affecting outcome. The exact age distribution of the deaths in this group is not given in the paper. So the level of performance in the management of major non-CNS injury is probably quite good. Obviously, the management of CNS-predominant injuries is not satisfactory in comparison. It is notable that the nearest neurosurgical unit to Leicester Royal Infirmary is located 26 miles away. I have myself experienced the problems of managing major trauma in hospitals without on-site neurosurgical advice. It should therefore be a priority to locate neurosurgical units on the same site as major accident and emergency departments. Where local neurosurgical expertise is not available very strict criteria should be applied for early transfer of patients. The study from Leicester suggests these would be the most effective initial measures for improving management of major trauma. T E J HEMS MA FRCS Wellcome Medical Research Fellow University of Edinburgh Edinburgh The paper by Phair et al. (Annals, January 1991, vol 73, pS3) raised the question of how many patients with ISS greater than 16 would be seen by a trauma centre which served a population of 2 million. Their population of 874 000 generated 93 such patients in 1 year. However, 56 prehospital deaths were also recorded. Assuming these cases to be scored ISS 75, a comparable population of 2 million would generate 340 cases of major trauma. Obviously, the question of workload depends upon the cases actually reaching hospital, but if prehospital resuscitation improves as much as we all hope and expect, in-hospital care
Comment
~ ~ ~ ~ ~ ~ ~ . ..
Transcholecystic operative cholangiography: an alternative technique
In response to the comments I made regarding the Gourevitch metal cannula for use during peroperative cholangiography (Annals, January 1991, vol 73, p43), I have received numerous requests for further information and in particular relating to the manufacturer as well as to its inventor.
o.e..
..;am ._iB
Figure 1.
The standard cannula is based on a 19G needle (Fig. 1) and is quite malleable. Since it is made of metal it can be autoclaved repeatedly and has a very long life span. The cannula can also be provided to varying specifications and is manufactured on request. The standard cannula has a connection piece suitable for most extension tubings in routine clinical use. They are available as a minimal order of ten cannulas (total cost £27.50) from: Steriseal Sales Department Thornhill Road Redditch West Midlands B98 9NL Tel: 0527 64222
....g....r
:~~~~~~~~~~~~~~~~~~~~~~~~~~............
The cannula was popularised by Arnold Gourevitch (Fig. 2), Consultant Surgeon at the Queen Elizabeth Hospital, Birmingham. The idea to develop the cannula came to him during a visit to Denmark in the 1960s when he was shown a cannula by one of the surgeons he met. He felt he could improve upon the design and asked a local firm to start producing it. Although it is used throughout the West Midlands it is curious that it does not seem to have become more widely adopted. Those who knew Arnold Gourevitch (he retired in 1979) will tell you the likely reason, for he had a quality which often accompanies that rare breed of a truly inventive master surgeon, namely utmost humility and an aversion to publicity. He also was, and remains, a very kind man, a fact of some relevance to the messenger! J P NEOPrOLEMOS MA MD FRCS Reader in Surgery Dudley Road Hospital Birmingham
Deaths following trauma: an audit of performance I read the above article (Annals, January 1991, vol 73, pS3) with
particular interest in view of the current efforts to improve trauma management. However, the overriding conclusion, which I made from the experience of Leicester Royal Infirmary, is that an improvement is required in the management of head injuries. This does not seem to have been particularly emphasised by the authors. There was only one preventable death from non-CNS injury among the patients under the age of 55 years as against 11 preventable deaths from CNS injury. While there were more deaths from non-CNS injuries among the patients over the age of 54 years, this group is obviously more difficult to treat with pre-existing medical conditions affecting outcome. The exact age distribution of the deaths in this group is not given in the paper. So the level of performance in the management of major non-CNS injury is probably quite good. Obviously, the management of CNS-predominant injuries is not satisfactory in comparison. It is notable that the nearest neurosurgical unit to Leicester Royal Infirmary is located 26 miles away. I have myself experienced the problems of managing major trauma in hospitals without on-site neurosurgical advice. It should therefore be a priority to locate neurosurgical units on the same site as major accident and emergency departments. Where local neurosurgical expertise is not available very strict criteria should be applied for early transfer of patients. The study from Leicester suggests these would be the most effective initial measures for improving management of major trauma. T E J HEMS MA FRCS Wellcome Medical Research Fellow University of Edinburgh Edinburgh The paper by Phair et al. (Annals, January 1991, vol 73, pS3) raised the question of how many patients with ISS greater than 16 would be seen by a trauma centre which served a population of 2 million. Their population of 874 000 generated 93 such patients in 1 year. However, 56 prehospital deaths were also recorded. Assuming these cases to be scored ISS 75, a comparable population of 2 million would generate 340 cases of major trauma. Obviously, the question of workload depends upon the cases actually reaching hospital, but if prehospital resuscitation improves as much as we all hope and expect, in-hospital care
