Partial rupture of the distal biceps tendon exhibits features similar to that of complete disruption, including acute antecubital pain, weakness of elbow flexion, and forearm supination, and differs only in the fact that the biceps tendon is still palpable in the partial rupture. There are 2 etiologies, first acute traumatic (such as a sudden eccentric contracture) and second, chronic degenerative tendon disease. For accurate diagnosis, a high index of suspicion must be employed. Initial investigations should include plain x-ray and a magnetic resonance scan. Partial tears <50% may be treated with nonoperative management or with surgical debridement of the surrounding synovitis. Tears >50% should be treated with division of the remaining tendon and surgical repair of the entire tendon as a single unit. Surgical endoscopy provides the ability to further quantify the extent of a distal biceps tear and to treat with debridement. This technique, however, should only be used in experienced hands.

Homicide-suicide forms a distinct form of homicide. An analysis of cases in the Yorkshire and Humberside region of England between 1991 and 2005 revealed 37 episodes with 42 victims. Previous studies have shown a high rate of use of firearms. Over the last 2 decades firearms legislation has become more restrictive. In this study all assailants were male, mean age 46.8 years. The commonest method of homicide was strangulation (36%) with 16% killed by firearms. This is a reduction compared with a previous study in the same region. All killers who shot their victims killed themselves with firearms. There were no multiple killings with firearms in this study and no stranger killings. Hanging was the commonest method of suicide. During the same period the use of firearms as a method of homicide increased in England and Wales with handguns, the most common weapon. Nationally, suicide after homicide has remained at a similar rate over the half century and is an uncommon phenomenon. Firearms use remains low in both homicide and homicide-suicide episodes in England, and further analysis is required to determine changes in patterns of killing.

No abstract

The UniCAT protocol uses less radiation than whole-limb spiral scans and is a method that can be used with all modern computer-assisted tomography machines. The coronal and sagital alignment results compare favourably with previous published reports without computer-assisted tomography. Component rotation has not previously been reported and its implications are yet to be defined.

Aqueous calcium sulphate as a sole grafting agent for void management after curettage simplifies current treatment practices and displays good bone reconstruction in a comparatively short time frame, with excellent functional results and acceptable complication rates in the setting of tumour surgery.

26 December 2004 is a date that changed the lives of incalculable numbers of persons the world over as a result of the Asian tsunami. Krabi Province was one of the more severely affected areas of Thailand, with many of the dead and injured being non-Thai, persons who were holidaying during the peak tourist season. Some injury types were comparatively underrepresented, such as head, thoracic and abdominal trauma. Does the classic trimodal distribution of death following injury help explain the types of injuries seen in the survivors of the disaster? Data are incomplete at this point in time, but with time it may be found that the trimodal model displays the pattern of death in mass casualty disaster situations. This may aid in the development of specific strategies to deal with similar events in the future.

SummaryBackgroundEstablishment of a cancer registry is a complex process that requires substantial resources and careful planning. There are numerous resources available to provide guidance for this, which include guidelines and frameworks of varying quality. It is the authors' goal to identify evidence‐based recommendations within the literature to help guide the process of designing a new registry with optimal efficiency, workability and data use. The objective of this study is to examine the primary literature for evidence‐based recommendations on how to design and establish a cancer registry, with a focus on literature which analyses the performance and usefulness of already established registries or guidelines.MethodsAn electronic search was completed in MEDLINE, CINAHL, EMCARE, SCOPUS and the Cochrane Database of Systematic Reviews. Recommendations were extracted from the identified articles and collated as themes.ResultsNine articles of varying quality were included in the review. Recommendations obtained from the literature included broad themes of the importance of clinician involvement, establishment of clear data definitions, number of variables used, inbuilt strategies to improve quality and completeness of data, considerations of costs, an ‘opt‐out’ strategy for ethics and privacy and flexibility of the system.ConclusionThis review concluded that there is a large gap in the primary literature for evidence‐based recommendations on the design and establishment of cancer registries. The included articles established a small scope of relevant themes, which were largely non‐specific. This area of deficiency provides an opportunity for future research, which would further strengthen the quality of current or new guidelines in cancer registry establishment.

The date 26 December 2004 saw a massive tidal wave propagated from a 9.0 Richter scale suboceanic earthquake off the coast of Sumatra in South-East Asia. It swept across the Indian Ocean over a matter of hours leaving destruction in its wake. In Southern Thailand, Krabi Hospital, that province's major tertiary health centre, received the majority of the region's tsunami victims. Well-rehearsed contingency plans were in place to cope with 10, 20 and 40 trauma victims in the case of an extreme event. By the end of 26 December some 500 injured people had been treated at Krabi Hospital: well in excess of the 'worst case scenario' planning. Over the following days a total of 1357 tsunami victims were treated. Over the course of the day victims were able to move through the hospitals' system and gain appropriate treatment. This was achieved through the almost superhuman dedication of the hospitals' well-trained nursing and medical staff. In addition to this were large numbers of both Thai and foreign volunteers, who aided people with basic necessities such as providing them with food, water and clothing as well as simple human comfort, some also acting as translators for the health-care workers and the masses of injured and displaced people. Makeshift wards were constructed in halls and little used areas of the hospital, using army style stretchers to accommodate the wounded. Even though the disaster contingency plans at Krabi Hospital were utterly overrun, the fact that well-thought out and practised strategies were in place saved incalculable lives. The message is clear: practised responses to mass trauma situations will save lives and allows health-care teams to coordinate well in the face of overwhelming odds without panic. All centres should routinely practise disaster response through scenario-based training.