We report the patient-scored Health-Related Quality of Life (HRQoL) and functional outcomes of a cohort of 21 consecutive patients undergoing nerve transfer surgery for traumatic upper brachial plexus injuries. Outcomes were assessed using the British Medical Research Council power grading system, Short-Form 36, Disability of Arm, Shoulder and Hand questionnaire, and Pain Visual Analogue Scale (PVAS). The mean age of our cohort was 29.8 years (range 18-53 years), with a mean follow-up period of 42.9 months. At follow-up, elbow flexion ≥ M3 strength was achieved in 17/21 patients. Shoulder abduction ≥ M3 was achieved in 14/19 patients. External rotation ≥ M3 strength was achieved in 11/15 patients. Delayed surgical repair correlated negatively with HRQoL outcomes. Higher injury severity scores and smoking were associated with higher PVAS scores. These findings provide key prognostic information for patients and peripheral nerve surgeons embarking upon this intensive pathway to potential recovery.

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Patients undergoing uncomplicated free flap surgery and those reporting superior post-operative flap aesthesis have higher HRQoL scores. Microvascular free tissue transfer has revolutionised our approach to the reconstruction of complex defects, providing a safe, reliable procedure to restore functionality and quality of life for patients.

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Three patients with AIDS who had cryptococcal meningitis were treated with liposomal amphotericin B after unsuccessful treatment with fluconazole and conventional amphotericin B. One patient responded but relapsed nine weeks later; he responded to a second course of treatment but again relapsed and subsequently died. Another patient deteriorated despite an improvement in cryptococcal antigen titres. The third patient was found to have culture negative CSF and treatment was therefore stopped. None of the patients suffered any adverse effects and renal function improved in all after conventional amphotericin was stopped and liposomal amphotericin B commenced.

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Previous studies of platelet aggregation have shown that platelet disc-to-sphere transformation induced by ADP is accompanied by a decrease in light transmission. Our studies were directed towards an understanding of this effect; they also resulted in the development of a method which quantitatively reflected platelet shape. A Payton aggregometer with a 0.5 ml cuvette was used. Electronic settings were standardized to give a read out of 100% transmission (10 mV) on the recorder with water in the cuvette, and 0% transmission (0 mV) with background current alone. For fresh, discoid platelet suspensions there was a fall in light transmission to a minimum at 200 r.p.m. with an increase in transmission to a maximum at 700 r.p.m. with increasing stirring speed After disc-to-sphere transformation by ADP, EDTA, or chilling, a constant light transmission, un-effected by stirring rate, was observed. When the changes in light transmission due to the disc-to-sphere transformation were measured, only a small decrease took place at 0 r.p.m. At 200 r.p. m. there was actually an increase due to the shape change, while maximum decrease was obtained at 700 r.p.m. This shows that the platelet shape change observed in the aggregometer is mainly determined by the difference of discoid and spherical platelets in their effect on light transmission in presence of stirring. When the ratio O.D.700/O.D.200 was determined for 38 suspensions of fresh normal PRP kept at 37°C, with platelet count ranging from 0.05 - 0.4 × 106 per mm3, there was little variation (0.66± 0.04 S.D.). The ratio approached unity with spherical platelets. With spherical and discoid platelets mixed in various ratios O.D.700/0.D.200 could detect as little as 10% change in discoid platelets, demonstrating that this ratio gives a sensitive, objective and quantitative reflection of platelet shape.