• Helen Dolan, specialist catastrophic medical negligence lawyer, recovered compensation in excess of £29million for clients with a brain injury (including cerebral palsy) in 2016
  • Hugh Potter secured a settlement figure of just under £13 million thanks to change in discount rate
  • Rachel Rees, expert personal injury lawyer, recovered over £15 million in compensation for clients with a brain injury last year

Amniotic Membrane Transplantation (AMT)

What is the amniotic membrane?

The amniotic membrane is the innermost layer of the placenta and can be used as a graft or dressing in a range of different surgical procedures, typically involving the eye. It is used for its anti-inflammatory and anti-scarring effects.

What is amniotic membrane transplantation (AMT)?

This describes the surgery performed in which the amniotic membrane is used as a graft or as a dressing.


In ophthalmology, AMT has been used in the revision of scars in the eye and also correcting defects following the removal of conjunctival tumours. However, such transplantations come with risks, including the transmission of infectious diseases.


Generally, the amniotic membrane is obtained through donors, who have been screened for diseases such as HIV, undergoing a caesarean section.


Surgeons clean the placenta with a mixture of salt solution, penicillin and other ingredients. The amnion is separated through sterile dissection and stored in a glycerol solution.

Apgar Score

Bartholin's Cyst

What is Bartholin’s cyst?

Also known as Bartholin’s duct cyst, it is a small sac of fluid that is found inside the opening of a woman’s vagina, within the Bartholin’s glands.


What are Bartholin’s glands?

These glands secrete fluid, used as lubricant during sex, into the vagina. They can become blocked and consequently expand to form a cyst. The exact reason for the blockage to occur is unclear but some links have been made with bacterial infections.

Complications

A Bartholin’s cyst typically occurs as a small, painless lump and is often identified during routine cervical screening examinations.


However, it can become infected, causing it to swell, become uncomfortable and affect the outer pair of lips surrounding the vagina. An infection can also lead to an abscess developing within one of Bartholin’s glands. If the area becomes swollen, tender and hot, and you have a temperature, that could indicate an abscess.

Treatment

Treatments for the abscess can include antibiotics to clear the infection that caused the blockage. Alternatively, the abscess or cyst may be drained, which should reduce the chances of the cyst developing in the future.


If these treatments are not effective, or if a woman experiences recurring cysts, then the Bartholin's gland may be surgically removed. However, risks of this type of surgery can include bleeding, bruising and infection of the wound.


Bile Duct Injury

What is bile?

Bile is a fluid in the digestive system that is stored in the gall bladder, which helps to break down food and get rid of toxins from the body.

Bile ducts and the biliary system

The biliary system is made up of a series of tubes and organs, beginning with the liver and ending with the small intestine. There is also a number of bile ducts, such as the common bile duct and the hepatic duct.

Causes of bile duct injuries

Injuries to the bile duct are most common during laparoscopic gall bladder surgery, where it may be cut, pinched or burned. If the bile duct is injured then it will not function correctly, which could result in bile leaking into the abdomen or a blockage of the normal flow of bile. This can be very painful, and even deadly, if not treated.

Symptoms

Bile duct injuries could cause the following symptoms:


  • Fever
  • Nausea
  • Abdominal pain
  • Vomiting
  • Swelling
  • Jaundice
  • Chills

Treatment and surgery

Once the injury to the bile duct has been noted, the main goal is to manage the infection and leakage caused by the injury. The surgeon may have to reconstruct the bile duct using a piece of intestine to bypass the blockage.


Most bile duct injuries are successfully repaired but in severe cases the patient may require months of recovery time.


Bowel Resection

Large bowel resection

This surgery removes all or part of your large bowel (also known as a colectomy). The large bowel connects the small intestine to the anus. Large bowel resection is used to treat many conditions, including:


  • A blockage in the intestine due to scar tissue
  • Colon cancer
  • Diverticular disease (disease of the large bowel)


Most people who have a large bowel resection recover fully. Even with a colostomy, most people are able to do the activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, other outdoor activities, and most types of work.


Small bowel resection

This surgery removes part or all of your small bowel (small intestine) when it is blocked or diseased.


Most digestion (breaking down and absorbing nutrients) of the food you eat takes place in the small intestine. The surgery can be performed laparoscopically or with open surgery.


Small bowel resection is used to treat:


  • A blockage in the intestine caused by scar tissue or congenital (from birth) deformities
  • Bleeding, infection, or ulcers caused by inflammation of the small intestine. Conditions that may cause inflammation include regional ileitis, regional enteritis, and Crohn's disease
  • Cancer
  • Carcinoid tumor
  • Meckel's diverticulum
  • Noncancerous (benign) tumors
  • Precancerous polyps


Most people who have a small bowel resection recover fully. Even with an ileostomy, most people are able to do the activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work. If a large part of your small intestine was removed, you may have problems with loose stools and getting enough nutrients from the food you eat.

Brain Aneurysm

An aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it branches.


As blood passes through the weakened blood vessel, the blood pressure causes a small area to bulge outwards like a balloon.




The medical term for an aneurysm that develops inside the brain is an intracranial or cerebral aneurysm.


Most brain aneurysms only cause noticeable symptoms if they burst (rupture).


This leads to an extremely serious condition known as a subarachnoid haemorrhage, where bleeding caused by the ruptured aneurysm can cause extensive brain damage.


If a brain aneurysm is detected before it ruptures, treatment may be recommended to prevent it rupturing in future. Most aneurysms won't rupture, so treatment is only carried out if the risk of a rupture is particularly high.


Cauda Equina Syndrome (CES)

Cerebral Palsy

Chron’s Disease

This is a long-term condition that causes inflammation of the lining of the digestive system.




Inflammation most commonly occurs in the last section of the small intestine (called the ileum) or the large intestine (the colon). However, the inflammation can affect any part of the digestive system, from the mouth to the back passage.


Symptoms of Chron's Disease include:


  • diarrhoea
  • abdominal pain
  • fatigue (extreme tiredness)
  • unintended weight loss
  • blood and mucus in your faeces


The exact cause of Crohn's disease is unknown. However, research suggests a combination of factors may be responsible. These include:


  • genetics
  • the immune system
  • previous infection
  • smoking
  • environmental factors


There's currently no cure for Crohn's disease, so the aim of treatment is to stop the inflammatory process, relieve symptoms (induce and maintain remission) and avoid surgery wherever possible.


The first treatment offered to reduce symptoms is usually steroid medication (corticosteroids). If this doesn't help, medication to suppress the immune system (immunosuppressants) and medication to reduce inflammation may be used.


In some cases, surgery may be needed to remove the inflamed section of intestine.


Crohn's disease is a relatively uncommon condition. There are currently at least 115,000 people living with the condition in the UK.

Chronic kidney disease

This long-term condition results in kidneys not functioning correctly or working effectively.


Symptoms of chronic kidney disease are not usually noticeable until later stages but it is usually detected at the early stages with blood and urine tests. Many symptoms of advanced kidney disease include:


  • tiredness
  • swollen ankles, feet or hands (due to water retention)
  • shortness of breath
  • nausea
  • blood in the urine

The kidneys' function is to filter the waste products from the blood before converting into urine. Our kidneys also help maintain blood pressure and the levels of chemicals in your body which help the heart function properly.


Chronic kidney disease is more likely to form the older you get and there is no cure. However, treatment can slow the progression of the disease.If the kidneys are damaged with diabetes or high blood pressure for example, then chronic kidney disease can develop.


Those with chronic kidney disease are more likely to have a heart attack due to the changes that occur in the blood circulation.


Read how a diabetic clinical negligence client of Lesley Herbertson underwent a leg amputation after he had an organ transplant due to chronic kidney disease.

Chronic Pain Syndrome

This is a condition, also known as complex regional pain syndrome, in which a person suffers from severe ongoing pain.


The cause of Chronic Pain Syndrome (CPS) is unknown but is thought to be the result of the body reacting abnormally to an injury. Some even thought the symptoms of CPS were psychosomatic or 'in the mind' but research has disproved this.


Other theories suggest that CPS is the result of a widespread abnormal response to an injury that causes several of the body's systems to malfunction including; the central nervous system, the immune system and the blood vessels.


Each of these systems are responsible for many body functions that are often affected in people with CPS.


The pain is usually confined to one limb but can sometimes spread to other parts of the body where it can become so sensitive that just a slight touch or bump can provoke intense pain.


Many cases of Chronic Pain Syndrome improve over time but many cases never go away and the affected person will experience pain for many years.



The pain experienced by sufferers is usually a burning, stabbing or stinging pain or a tingling sensation and numbness.


The pain may last periods of a few days or weeks in flare-ups where the discomfort gets worse. Stress can be a trigger of this which is why relaxation techniques are often used when treating CPS.


Not only are the physical symptoms an issue with Chronic Pain Syndrome but the emotional strain of living with CPS can sometimes lead to psychological problems such as depression and anxiety.


There is no known cure for Chronic Pain Syndrome but sufferers are often given a combination of physical treatment, medication and psychological support in order to manage the symptoms.


Read about a client of PotterReesDolan who suffered with Chronic Pain Syndrome here.

Compartment Syndrome

This is a painful, and potentially serious condition, where an enclosed body space (such as a bundle of muscles or tissue) swells and so pressure increases.




Pressure builds within the compartment which affects the function of the muscle and tissue.


There is then a lack of oxygenated blood to the area which can cause the tissue to die. If left untreated, then it could result in a loss of a limb.


Read about our client who was wrongly diagnosed with Deep Vein Thrombosis when in fact she had compartment syndrome. She was diagnosed too late which resulted in an above knee amputation.

Corneal Graft/Transplant

This is an operation to remove the damaged cornea in the eye and replace with healthy tissue to improve sight or treat a severe infection.


The cornea is the clear outer layer of the eyeball which acts as the lens of the eye which is made up on six delicate layers. When the cornea becomes damaged it can prevent light from reaching the retina which can make images appear unclear.


A corneal graft/transplant can be performed in a number of ways. These include: penetrating keratoplasty which is a full-thickness transplant, a deep anterior lamellar keratoplasty which involves replacing or reshaping the outer and middle cornea and a endothelial keratoplasty where the deeper parts of the cornea are replaced.


After about one in five corneal transplants, the patient may reject the foreign body as the immune system attacks the transplanted cornea. This rejection can often be treated with a dose of steroid eye drops.


Other complications after a corneal transplant include astigmatism where the cornea is not a perfectly curved shape as it should be. The pressure could build up in the eye resulting in trapped fluid, which is known as glaucoma.


Also, uveitis may occur whereby the middle layer of the eye becomes inflamed. Retinal detachment can also occur which is where the thin lining at the back of the eye (retina) begins to pull away from the blood vessels which supply it with oxygen and nutritions.

Deep Vein Thrombosis (DVT)

This is a blood clot in one of the deep veins in the body, usually in the large vein in the leg.

The blood clot can cause pain and swelling in the leg and can lead to complications such as pulmonary embolism.



Anyone can develop deep vein thrombosis but those with a family history, who are overweight or with other medical conditions such as cancer can be more at risk.


Another common cause of DVT is after undergoing an operation and it's estimated that 25,000 people who are admitted to hospital die from preventable blood clots each year.


This is because if you are unwell or inactive, or less active than you usually are, blood tends to collect in the lower parts of your body due to your lack of movement.


Treatment usually involved taking blood thinning medication to help reduce the blood's ability to clot.


Read about our client who was diagnosed with DVT but then developed compartment syndrome which resulted in her having an above knee amputation the same day.

Disc Protrusion

This protrusion, or bulge, can occur anywhere along the length of the spinal column from the neck (cervical spine) to the lower back (lumbar spine).


Doctors pay close attention to the patient's symptoms before more focussed procedures because sometimes the pain may occur in one part of the body but the actual cause lies in a different part of the spine.


If the pain is in the lower back (lumbar spine), leg or the groin, this could be irritation on the disc itself or irritation of the nerves next to the spine.

When the slipped disc presses on a nerve in the lumbar spine causing pain to spread below the knee (known as Sciatica), this can cause numbness or pins and needles or even a difficulty in lifting the toes and the foot.


The causes of disc protrusion or a slipped disc are when the outer case of the disc splits leaving the gel inside bulging out of the disc. This can then then put pressure on the spinal cord or a single nerve root, as explained above.


Age can sometimes play a part as the spinal discs start to lose their water content which makes them more flexible.


Recovery from a slipped disc can take around four to six weeks with treatment usually including a combination of physical therapy and medication.


In many cases, a slipped disc will eventually shrink back away from the nerve and the pain will ease as the disc stops pressing on the nerve.

Emergency Caesarean Section

This procedure is usually carried out when a normal vaginal delivery would put the mother or the baby at risk.


However, an emergency caesarean is performed when circumstances before or during labour call for an unplanned procedure.


A caesarean section is usually carried out under an epidural or a spinal anaesthetic causing the lower part of the body to be numbed. The procedure usually takes 40-45 minutes but, during an emergency, can be performed quicker.


The risks to the mother in a caesarean section can include an infection of the wound or the womb lining, a blood clot (thrombosis) in the legs or excess bleeding.


Doctors now give the mother a dose of antibiotics before the operation to reduce the likelihood of any infections.


Risks to the baby during a caesarean, according to the NHS, are no greater than a normal vaginal delivery but the most common problem of babies delivered by caesarean is difficulty breathing, although this usually affects babies born prematurely.

Encephalitis

This is a very rare condition but is very serious as it causes inflammation on the brain.


Symptoms can be flu-like, such as high temperature, headache and joint pain. More serious symptoms can then develop in a matter of hours. These can include changes in personality and behaviour as well as confusion or drowsiness and even seizures, These are classed as a medical emergency and an ambulance should be called immediately.


There are different types of encephalitis with various causes such as a viral infection or the immune system reacting to a previous infection. Treatment can include anti-viral medication or steroid injections.


Some people make a full recovery, some experience memory loss or epilepsy and some suffer permanent brain damage.


Here you can read about a PotterReesDolan client who suffered a brain injury after her encephalitis was misdiagnosed and treatment was delayed.

Endometriosis

This is a condition where tissue which behaves like the lining of the womb (endometrium) is found outside the womb. This is a common condition which is said to affect around 2 million women in the UK. [source]


The symptoms of endometriosis varies from woman to woman but the most common include; painful or heavy periods, pain in the lower abdomen, pelvis or lower back, pain during and after sex, bleeding between periods and difficulty getting pregnant.


The exact cause of endometriosis is unclear and there are many different theories. One theory is that endometriosis is hereditary where it has been passed down through the genes.




Another theory is that it is caused by retrograde menstruation which is when the womb lining flows backwards through the fallopian tubes into the abdomen instead of leaving the body as a period. The tissue then embeds itself into the pelvic organs and grows.


There is no cure for endometriosis but treatments are available to help ease the symptoms including; pain relief and hormone injections. Alternatively, surgery may be performed to remove the endometriosis tissue through laparoscopy or even hysterectomy.


Endometriosis can sometimes cause fertility problems through damaging the ovaries or fallopian tubes but it is said that up to 70% of women with mild-mid endometriosis have no problems getting pregnant after treatment.

Epilepsy

This condition affects the brain and causes repeated seizures.


Seizures occur when the neurons in the brain fire off abnormal bursts of electrical impulses which can cause the brain and body to behave strangely.


Neurons usually conduct electrical signals and act as chemical messengers to communication to each other in the brain.


There are an estimated 500,000 people in the UK who have epilepsy and the severity of their seizures can differ from person to person; from going into a trance like state for a few seconds to losing consciousness and having convulsions.


Epilepsy can be diagnosed in childhood in some people but is also a very common side effect to a brain injury.


Medication can be prescribed but anti-epileptic drugs cannot cure the condition but are effective in controlling seizures.


Some people with epilepsy may undergo surgery to remove a specific area of the brain that is affected or install an electrical device to help control seizures.

Erb's Palsy

This condition is usually caused by a traumatic childbirth where the baby's arm is paralysed when the upper group of the arm's main nerves is injured.


Erb's Palsy, or otherwise known as brachial plexus paralysis, can occur if the infant's head and neck are pulled toward the side at the same time as the shoulders pass through the birth canal.


The condition can also be caused by excessive pulling on the shoulders during a cephalic presentation (head first delivery), or by pressure on the raised arms during a breech (feet first) delivery.



Other causes can include a raised BMI of the mother at time of baby's birth, a high weight at birth and a long second stage of labour.


The child is usually unable to abduct the arm from the shoulder, rotate the arm externally from the shoulder or supinate the forearm giving them a 'waiter's tip' appearance.

Hand grasp in children with Erb's Palsy is usually normal unless the lower part of the plexus is also damaged.


Some babies recover on their own but some need specialist treatment.

Gestational Diabetes

Diabetes is condition where there is too much glucose in the blood which is controlled by a hormone called insulin.


The illness is caused by either insufficient insulin being produced or the body is becoming resistant to insulin.


Gestational diabetes is when, during pregnancy, the woman's body produces a number of hormones which make her body insulin-resistant. The purpose of this hormonal effect is to allow the extra glucose and nutrients in your blood to pass to the foetus so it can grow.


Her body should produce more insulin in order to cope with the increased amount of glucose in the blood. However, some women cannot produce enough insulin in pregnancy to transport the glucose to the cells or their body is becoming more resistant to insulin.


Pregnant women may be more likely to have gestational diabetes if her body mass index is high, if they have previously had a baby weighing more than 10lbs at birth or if they have a family history of diabetes.


Some women may need medication to control their glucose levels but most can control the gestational diabetes through diet and exercise.


Gestational diabetes is usually developed after 28 weeks and usually disappears after the baby is born. However, women who develop gestational diabetes are more likely to develop type 2 diabetes later in life.


If the gestational diabetes is not detected it can cause problems during and after birth.


These include; a risk of the child becoming obese or have diabetes later in life, trauma during birth and placental abruption whereby the placenta starts to come away from the wall of the womb which can cause vaginal bleeding and abdominal pain.


Other complications which can occur include; needing to induce labour, premature labour and even perinatal death, where the baby dies around the time of the birth.

Girdlestone Procedure

Glomerular Filtration Rate (GFR)

This is the way in which the level of kidney function is measured and determines the stage of kidney disease.


It is calculated from the results of a blood test, as well as the age, body size and gender of the individual.


The blood test aims to measure the levels of a chemical called creatinine which is a breakdown product of muscle. It is normally cleared from the blood by the kidneys and so, if the kidneys are not working properly, then the level of creatinine in the blood goes up. The test also estimates how much blood passes through the filters in the kidneys (the glomeruli).


The stages of chronic kidney disease are shown below with the GFR listed:


#


Hypertension

Another name for high blood pressure, hypertension means that the blood pressure is continually higher than normal and rarely shows any symptoms.


As hypertension has no obvious symptoms, the only way to check is to have your blood pressure measured. However, in some rare cases of very high blood pressure, the individual mat experience a persistent headache, blurred vision and nosebleeds.


In most cases, the cause of hypertension is unknown but the risk can be increased due to age, a family history of high blood pressure, a high amount of salt in your food, being overweight and drinking large amounts of alcohol.


A small percentage of hypertension cases are as a result of underlying conditions such as; kidney disease, diabetes, hormonal conditions and the oral contraceptive pill.


If untreated, hypertension could cause a stroke or heart attack and kidney disease.

Hypoxic-Ischemic Encephalopathy (HIE)

This brain injury occurs in newborn babies and is caused by oxygen deprivation to the brain, also known as intrapartum asphyxia.


Although a newborn's body can manage for brief periods of time with reduced oxygen, if it lasts too long then the brain tissue is destroyed.


Hypoxic-ischemic encephalopathy due to fetal or neonatal asphyxia is a leading cause of death or severe impairment among infants.


Effects of this brain injury can include delays in neuro-development, cognitive impairment and epilepsy; the area of the brain injury can depend on the timing and severity of the asphyxia.


MRI scans are usually performed once hypoxic-ischemic encephalopathy is suspected to aid diagnosis.


Although there is no definite cure for HIE. any treatment includes helping the child adapt to symptoms of the brain injury and physical and occupational therapy is commonly used.


HIE.jpg

Laminectomy

This is one of the most common back surgeries where a surgeon removes the rear portion of one or more spinal bones (vertebrae).


Ligaments and bones that are pressing on the nerves may be removed at the same time during surgery.

Laminectomy.jpg

People with arthritis in their spine can sometimes develop bony overgrowths within the spinal canal which can cause the pressure.


As with any form of surgery, there can be complications during a laminectomy including:


  • Bleeding,
  • Infection blood clots,
  • Nerve injury


Orthopaedic injuries can also occur during surgery in which case a clinical negligence claim may be brought against the hospital.


Most people who undergo a laminectomy see an improvement in their symptoms but, as the spine ages over time, the benefit may lessen.

Laparoscopic Cholecystectomy

This is a surgical procedure to remove the gall bladder through a 'key hole' method whereby the surgeon inserts a thin tube with a camera to view the gall bladder on a screen.


The use of a laparoscope is a less invasive method, using several small incisions rather than one large one. Other benefits of a laparoscopic procedure usually include a shorter hospital stay, shorter recovery time and therefore less time off work.


There is usually also less pain with this procedure than with a normal cholecystectomy due to the fact that the abdominal muscles have not been cut open.


The removal of the gall bladder is one of the most common operations performed in the UK.

ds00165__ds01153_my00372_im03662_d7_cholecystectomythu_jpg.png

Bile, the digestive fluid which helps break down fatty food, is stored in the gall bladder.

Sometimes the cholesterol, salts and waste products become out of balance causing gallstones to develop.


When the gallstones become an issue, this is when a laparoscopic cholecystectomy is usually recommended.


Gallstones can often have no symptoms and can remain undetected. However, they can become trapped in the bile duct, irritate and inflame the gallbladder or travel to other parts of the body.


Your body will still function without the gallbladder - the liver will still produce bile to digest food.

However, some people have reported bloating and diarrhoea when eating certain foods.

Microdiscectomy

This is a form of spinal surgery to decompress the spine using a microscope to view the spine and the lumbar disc.



A small portion of the bone over the nerve root is removed to relieve neural impingement and to provide the nerve with more room to heal.


Compression of the spine can cause substantial leg pain and a microdiscectomy is usually performed for a herniated lumbar disc which is said to be more effective for treating leg pain than lower back pain.


The success rate of a microdiscectomy is approximately 90-95% with 5-10% of patients developing a recurrent disc herniation at some point in the future.


In any spinal surgery, there is the risk of a cerebrospinal fluid leak which occurs in 1-2% of these procedures. This means the patient will have to lay horizontally for one or two days to allow the leak to seal. Other complications can include; nerve root damage, bleeding or infection.

Myocardial Infarction

This means 'damaged heart muscle' and is the most serious type of heart attack which needs to be treated quickly to minimise the damage to your heart.


It is usually due to a blood clot in a coronary artery in the heart which stops the blood flowing to the heart muscle.




The most common symptom of Myocardial Infarction (MI) is severe chest pain which may also travel up into your jaw and down your left or both arms.


However, some people only have mild discomfort in the chest which can sometimes feel like indigestion or heartburn.


Treatment of MI varies but usually includes pain relief medicine and restoring the blood flow in the blocked coronary artery.


Although many people make a full recovery after a Myocardial Infarction, complications can include; heart failure, abnormal heart rhythms and even a further MI.

Necrotising Enterocolitis

Ovarian Hyperstimulation Syndrome

This is a rare but serious consequence of taking fertility drugs during in-vitro fertilisation (IVF) treatment.


This complication occurs in women who are very sensitive to the fertility drugs taken to increase egg production, causing too many eggs are produced which makes the ovaries become very large and painful.


Symptoms of Ovarian Hyperstimulation Syndrome (OHSS) begin with abdominal pain and bloating; these symptoms usually appear 4 or 5 days after the eggs are collected.


More severe symptoms include low levels of protein in the blood and decreased output of urine which can become very dangerous.


OHSS is more common in women under 30 and those with Polycystic Ovary Syndrome.


A mild degree of OHSS occurs in 33% of IVF treatment whereas the more severe cases occur in 1-2% of IVF where the patient is ill with severe pain, nausea and vomiting.

Pressure Sores (Ulcers)

These occur when the skin is placed under pressure and can range in severity; from discoloured skin to open wounds which expose bone or muscle.


Pressure sores can develop when a large amount of pressure is applied over a short period of time or a small amount of pressure over a longer period of time. They can form, for example, when recovering from an operation when confined to lying in a bed for long periods of time.


If the patient's position is changed regularly, then pressure sores can be prevented as blood flow can be undisturbed. A care team would develop a repositioning timetable to set out how often someone needs to be moved in order to prevent or reduce the impact of pressure sores.


Here you can read about a client who developed pressure sores after suffering a spinal cord injury when he was left in bed too long and rotation procedures were not followed.


Even when pressure sores have been cared for properly, complications can arise with grade 3 or grade 4 pressure sores potentially life threatening. An elderly client of PotterReesDolan sadly passed away after developing pressure sores and subsequently pneumonia.


Pressure sores can also be an issue for people in wheelchairs as they can often be provided with unsatisfactory equipment, meaning sores can develop due to the prolonged pressure on the skin.

Pulmonary Embolism

This condition occurs when there is blot clot in the artery that carries blood to the lungs.


This blockage can be potentially life-threatening as it can prevent blood from reaching the lungs.


Symptoms of a pulmonary embolism can include; chest or upper back pain, shortness of breath, coughing and feeling faint or dizzy.


The blood clot most commonly travels from a deep vein in the leg (known as Deep Vein Thrombosis) up to the lungs or the heart.

Pulmonary.jpg

This can occur for no apparent reason but is usually caused by prolonged inactivity.


The main treatment for pulmonary embolism is through anticoagulant medication which stops the blot from clotting easily and helps the body absorb it. In more severe cases, the blockage may be removed through injections or surgical procedures.


This is because the blood tends to collect in the lower parts of the body when stationary, such as in hospital, which is where around half of the people who develop pulmonary embolism do so.


Severe cases of pulmonary embolism can lead to collapse, abnormally low blood pressure, and even sudden death.


The mortality rate of pulmonary embolism is dependant on the amount of lung which is affected and whether the patient has any other medical conditions.

Pulseless Electrical Activity (PEA)

This is a clinical diagnosis of cardiac arrest where the heart doesn't pulse as it should.


The heart rhythm is observed on the electocardiogram but the heart is either not contracting or there may be insufficient cardiac output to generate a pulse and blood supply to the organs.

As PEA leads to loss of cardiac output, the blood supply to the brain is interrupted. Therefore, the person usually loses consciousness and stops breathing.


However, the heart does have some electrical activity on the monitor as opposed to a flatline (asystole).

Radio Necrosis

This is a major complication following the use of radiotherapy on cancerous tumours when normal tissue is destructed. Necrosis means the death of cells in bones, organs, and soft tissues.


Radiotherapy is common method used to treat cancer, but it can also affect the rest of the body as the tissue in the surrounding area is also exposed.


Tissue damage begins once the patient is exposed to the radiation beam. The damage starts to interfere with the normal processes of supplying blood to the irritated areas, causing the tissue to change.


If a surgeon attempts to repair the damaged tissues, he or she may confront numerous complications. When attempting a skin graft, the surgeon has to connect to tissues that are ischemic (where there is a restricted blood supply) which means the tissue may heal with difficulty or not at all.


Radio necrosis develops in four stages:


  • Acute clinical period (first six months) : No clinical signs may arise during the first few months unless tissue therapy has exceeded its radiation tolerance limits.

  • Sub acute clinical period (second six months) : The recovery from acute radiation damage ends and permanent damage becomes evident.

  • Chronic clinical period (second to fifth year) : Further damage occurs and the most significant problems arise due to chronic deterioration of the microvasculature and tissue damage.

  • Late clinical period (after five years) : Physicians should be alert to signs of new cancers at this stage as soft tissue radio necrosis develops quite slowly. Very few recognisable skin changes arise during first six to 12 months after radiation damage.

Salpingo-Oophorectomy

This is a surgical procedure which can be either unilateral or bilateral.


Unilateral is where the fallopian tube and an ovary are both removed and a bilateral procedure involves the removal of both sets of fallopian tubes and both ovaries are removed.


In a salpingo-oophorectomy, a woman's reproductive organs are accessed through an incision in the lower abdomen, or laparoscopically (A). Once the area is visualized, a diseased fallopian tube can be severed from the uterus and removed (B and C). The ovary can also be removed with the tube (D). The remaining structures are stitched (E), and the wound is closed. (Illustration by GGS Inc.)


The reasons for this surgery to be performed is usually to treat forms of gynaecological cancer or pelvic inflammatory disease.


This procedure may also be done to treat endometriosis as well as if a woman has been diagnosed with an ectopic pregnancy.


Salpingo-oophorectomy is considered major surgery if performed through an abdominal incision and would require three to six weeks to fully recover.


However, if the procedure if performed laparoscopically, the recovery time can be much shorter.

Immediately following the operation, sharply flexing the thighs or the knees should be avoided.

And if the patient suffers with persistent back pain or blood in the urine then it may indicate that a ureterhas been injured during surgery.


Other complications, as with most major surgeries, can include infection, haemorrhage and scars at the incision.


Complications after a salpingo-oophorectomy, however, can include changes in sex drive, hot flashes and other menopausal symptoms if both ovaries are removed.


In general, studies have shown that the complication rate following salpingo-oophorectomy is essentially the same as that following hysterectomy.

Sarocolpopexy

This is a surgical technique used to repair a pelvic organ prolapse to restore the vagina to its normal position and function.


Reconstruction can be made using an open abdominal technique or through minimally invasive surgery such as a laparoscopy, depending on the severity of the pelvic prolapse.


A permanent synthetic mesh is used as a graft to cover the front and back surfaces of the vagina. The mesh is then attached to the tail bone and covered by a layer of tissue which lines the abdominal cavity called the peritoneum which prevents the bowel getting stuck to the mesh.


Although the majority of women fully recover from this surgery, there is a small risk that a prolapse can develop in another part of the vagina which could require further surgery.


Other complications can include; pain during intercourse, exposure of the mesh in the vagina and damage to the bladder, bowel or ureters. There are also more general risks associated with this surgery such as wound infection or a urinary tract infection.

Scaphoid Fracture

The scaphoid bone is one of the carpal bones around the area of the wrist. Fractures of scaphoids can occur with direct compression or hyperextension of the wrist. The symptoms often include pain and swelling around the wrist and tenderness over the thumb side of the wrist.


Scaphoid fractures are categorised by location. They are often diagnosed by X-rays but it is important to remember that scaphoid fractures are not always apparent on the initial X-rays. Treatment usually consists of providing a cast.


If there has been some movement of the bone fragment(s), the scaphoid bone can heal in an incorrect position and you might need surgery to correct this. In some circumstances, a bone graft may also be needed to correct the deformity and to promote healing.

However, an important possible complication in scaphoid fractures is avascular necrosis. Avascular necrosis is usually visible on X-rays.


This complication and the risk depends upon the location of the fracture. This is more common where a fracture occurs at the narrowest part of the scaphoid which is where the blood supply enters to the scaphoid bone.


If the blood supply is interrupted, it can leave part of the bone without a blood supply.


Sometimes scaphoid fractures are mistakenly assumed to be a sprain and it may be that you are unknowingly applying pressure to the injured wrist.


We have a more detailed summary on this type of fracture in our orthopaedic injuries section as well as a blog from Helen Shaw on why these fractures are so common and frequently missed.


Here you can read how a client suffered scaphoid injuries, as well as a spinal cord injury, after being in a motorcycle accident.

Septicaemia (Sepsis)

Spinal Cord Abscess

Spinal cord abscess is a rare condition capable of causing permanent damage to the spinal cord.


Abscesses are caused when injured tissue becomes infected. The body’s immune system sends white blood cells to help fight off the infection. They begin to fill the damaged tissue, causing pus to build up. Pus is made up of the dying tissue, immune cells, dead cells, and bacteria.

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The cause of Spinal cord abscess is generally due to the introduction of bacteria into the spinal cord. Once inside the body, it is able to find a place to live and grow. The pressure of the abscess on the spinal cord will sometimes cause neurological problems, such as lower-body paralysis and loss of sensation below the area of the abscess.


Doctors will try to find the presence of an infection by testing body fluids. They may also look at an image of the abscess. Once the diagnosis is confirmed, they will have to either drain or remove the abscess.


Patients will generally receive antibiotics to take after they leave to avoid getting an infection. Since antibiotics have come into common medical use, Spinal cord abscess has become extremely rare. In fact, fewer than 100 cases have been reported in modern medical history

Quick recognition of spinal cord abscess is important in effectively treatment. Left alone, the abscess could burst, letting millions of bacteria spread throughout the body. Once the problem is identified, treatment for spinal cord abscescan include:


  • Laminectomy


The patient is put under anesthesia before the surgery. Surgeons open the abscess carefully and drain all the fluid. They then rinse sanitary saline fluid through the abscess to assure all bacteria are gone.


  • Intraoperative Pus Collection.


During this procedure, fluid is collected from the abscess for testing.


  • Closure of Dermal Sinus


Doctors who find a dermal sinus will typically close the gap. The hope is there will be one less place for bacteria to gather and form an infection.

The earlier a spinal cord abscess is treated, the more positive the outlook. Patients who have a leaking abscess are unleashing bacteria into the bloodstream. They could end up with abscesses on the brain or liver.


Patients who get treatment after the start of neurological symptoms generally will need a form of rehabilitation. The hope is that over time the neurological symptoms will get better or disappear.

Spinal Cord Compression

This happens when there is pressure on the spinal cord. This may be caused by cancer growing in or spreading into the bones of the spine, which occurs in 5% of people with advanced cancer.


Spinal cord compression may also occur when the spinal cord becomes injured through a trauma such as a car collision, or when the bones become weak (osteoporosis) or infection.


The pressure on the spinal cord stops the nerves working normally which causes a variety of symptoms including; pain or tenderness in the back which may be worse when coughing or sneezing, numbness or weakness in the legs and changes in sensation in parts of the body e.g. pins and needles.

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Symptoms vary from person to person depending on the location of the compression on the spine but they may also include bowel functionality problems, erectile problems in men and a band of pain down your arm or leg.


Recovery of spinal cord compression also varies between patients; from complete recovery to complete paralysis.


Those diagnosed with a spinal cord compression would be referred to a neurosurgeon. Patients with regional spinal cord lesions would have an emergency decompression of the spine.


The patient, however, would have to have surgery if the spinal nerves were impinged or if there was neurological deterioration.


Long term treatment would include rehabilitation including physiotherapy and occupational therapy.


Spinal epidural haematoma - Over Anti-coagulation

This injury can be caused by a number of factors including childbirth or surgery where bleeding into the epidural space in the spine can occur.


However, here we are focusing on epidural haematoma caused by over anti-coagulation.


In the spine, the epidural space contains loose fatty tissue and a network of large, thin-walled veins. This means that bleeding is likely to be venous.


Anatomical abnormalities and bleeding disorders make these lesions more likely. They may cause pressure on the spinal cord or cauda equina. The diagnosis may be made on clinical appearance and time course of symptoms. It usually requires MRI scanning to confirm. The treatment is surgical decompression.


However, when epidural haematoma is caused by over anti-coagulation, the sufferer will be on anticoagulant medication which prevents the blood from clotting.


Over anti-coagulation is when the patient has taken too many anticoagulant drugs which can result in bleeding or bruising easily. This can then affect the epidural space and can lead to haematoma and even paraplegia.


Read about a case of Helen Dolan's which settled for a lump sum of £2.3 million after an elderly woman suffered an epidural haematoma due to over anti-coagulation.

Spondylitis

This is an inflammation of the vertebra and is a form of chronic arthritis which affects the bone, muscles and ligaments.


The spine is made up of 24 individual vertebrae which are separated by soft pads that act as shock absorber which allow the spine to bend. The vertebrae are also held together by ligaments and spinal muscles, giving the back its strength.


The symptoms of spondylitis can vary between each patient but generally people suffer from back pain and stiffness, usually taking a long time to develop, and fatigue if let untreated. The back pain in sufferers usually gets worse with rest and can often wake them up during the night.


This condition can be severe, with one in 10 people at risk of a long term disability.


The causes of spondylitis are not fully understood but a particular gene (HLA-B27) has been identified that is closely linked to the condition. However, if you have the gene then you may not necessarily have the condition.


In order to diagnose spondylitis, you may have blood tests to measure how much swelling you have in your body.


Further tests may include x-rays to see if there is any damage to the joints in your spine.


Unfortunately, there is no cure for spondylitis but there are treatments available to help ease the symptoms and slow the process of the spine stiffening, which include; physiotherapy, painkillers and other medicines.


As Spondylitis is such a complex condition, it can also lead to additional health problems; including Cauda Equina Syndrome.

Squamous Cell Carcinoma

This is an uncontrolled growth of abnormal cells arising in the squamous cells - the thin, flat cells that make up the outer layer of the skin (the epidermis).


Squamous Cell Carcinomas (SCCs) often look like scaly red patches, open sores, or elevated growths with a central depression.


This is the one of the major forms of skin cancer as they are usually found in areas frequently exposed to the sun due to increasing UV exposure on the skin over time.


For this reason, they more commonly found in people with an outdoor profession/lifestyle, the elderly or those with a fair complexion susceptible to burning.


However, SCCs can also occur in other tissues such as; lips, mouth, oesophagus, urinary bladder, prostate, lung, vagina, and cervix.


The symptoms of an SCC can vary but it begins as a small nodule and, as it enlarges, the centre becomes necrotic and sloughs and the nodule turns into an ulcer. This usually presents itself as an ulcerated lesion with hard, raised edges.


The tumour itself may be in the form of hard plaque often with tiny blood vessels. It can lie below the level of the skin and eventually invades the underlying tissue.


Squamous Cell Carcinomas are usually investigated through a biopsy and classified under a microscope to determine the subtype.


They are generally treated by surgical excision although there is the option to use topical chemotherapy and radiotherapy. Radiotherapy is usually used as treatment in patients for whom surgery is not feasible.


The common prognosis of Squamous Cell Carcinoma is positive with less than 4% of cases spreading to other parts of the body. Some particular forms of SCCs have a higher, though still positive long-term outcome.

Stoma


A stoma is an opening on the front of your abdomen (tummy) which is made using surgery. It diverts your faeces or urine into a pouch (bag) on the outside of your body.


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A stoma is a bud-like structure, which sits on the surface of your skin on your abdomen. It’s formed during surgery and can be either temporary (and reversed later) or permanent. A stoma collects faeces from your bowel or urine from your urinary tract, which have been diverted from their normal route through the body.


Once you have a stoma fitted, you should be able to carry on with life as normal. You need to keep it clean and change the collection bag regularly.


You may need to have an ileostomy or colostomy if you have bowel cancer or inflammatory bowel disease. Sometimes a temporary stoma is created to allow an internal join in your bowel to heal after surgery. You may need to have a urostomy if you have surgery for bladder cancer, severe urinary incontinence or damage to your pelvis.

Subarachnoid Haemorrhage

This is an uncommon type of stroke caused by bleeding on the surface of the brain. It's a very serious condition and can be fatal.


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Subarachnoid haemorrhages account for around 1 in every 20 strokes in the UK.


There are usually no warning signs but a subarachnoid haemorrhage sometimes happens during physical effort or straining – such as coughing, going to the toilet, lifting something heavy or having sex.


A person with a suspected subarachnoid haemorrhage needs a computerised tomography (CT) scan in hospital to check for signs of bleeding around the brain.


If a diagnosis of subarachnoid haemorrhage is confirmed or strongly suspected, you're likely to be transferred to a specialist neurosciences unit.


Medication will usually be given to help prevent short-term complications and a procedure to repair the source of the bleeding may be carried out.


The majority of subarachnoid haemorrhages are caused by a brain aneurysm bursting. A brain aneurysm is a bulge in a blood vessel, caused by a weakness in the blood vessel wall.


It's not known exactly why brain aneurysms develop in some people. However, certain risk factors have been identified, including:


  • smoking
  • high blood pressure
  • excessive alcohol consumption

Severe head injuries often cause subarachnoid bleeding, but this is a separate problem known as a "traumatic subarachnoid haemorrhage". Although the outlook for subarachnoid haemorrhage has improved in the last few decades, around half of all cases are fatal, and people who survive can be left with long-term problems.


Recovering after a subarachnoid haemorrhage can also be a slow and frustrating process, and it's common to have problems such as:


  • extreme tiredness
  • headaches
  • problems sleeping

Subdural Haematoma

A subdural haematoma is a serious condition where blood collects between the skull and the surface of the brain. It's usually caused by a head injury.


a headache that keeps getting worse Symptoms of a subdural haematoma can include:

  • feeling and being sick confusion
  • personality changes, such as being unusually aggressive or having rapid mood swings
  • feeling drowsy
  • loss of consciousnessSubdural-Hematoma-photos.jpg

The symptoms can develop soon after a severe head injury (acute subdural haematoma), or very occasionally a few days or weeks after a more minor head injury (subacute or chronic subdural haematoma).


A subdural haematoma occurs when a blood vessel in the space between the skull and the brain (the subdural space) is damaged.


Blood escapes from the blood vessel, leading to the formation of a blood clot (haematoma) that places pressure on the brain and damages it.

Head injuries that cause subdural haematomas are often severe, such as those from a car crash, fall or violent assault. However, minor bumps to the head can also lead to a subdural haematoma in a few cases.


A minor head injury is more likely to lead to a subdural haematoma if you're over 60 years of age, taking blood-thinning medication such as warfarin, or have a history of alcohol misuse.


Subdural haematomas usually need to be treated with surgery as soon as possible. The two most widely used surgical techniques for subdural haematomas are:


  • craniotomy – a section of the skull is temporarily removed so the surgeon can access and remove the haematoma
  • burr holes – a small hole is drilled into the skull and a tube is inserted through the hole to help drain the haematoma

In a few cases, very small subdural haematomas may be carefully monitored first to see if they heal without having an operation.


A subdural haematoma is a serious condition that carries a high risk of death, particularly in older people and those whose brain was severely damaged.


Acute subdural haematomas are the most serious type because they're often associated with significant damage to the brain. Those who survive an acute subdural haematoma may take a long time to recover and may be left with physical and mental disabilities.

Ulcerative Keratitis

This is a corneal ulcer which is an open sore that forms on the cornea, usually caused by infections; both viral and fungal.


Even small injuries to the eye, or erosion caused by wearing contact lenses too long or while sleeping, can lead to infections.


Those who wear contact lenses are more susceptible to ulcerative keratitis although an ulcer can occur due to 'dry eye', an injury to the eye or an inflammatory disorder.


Ulcerative keratitis causes the eye to become inflamed and sore, causing excessive tearing and blurred vision. The ulcer should be treated as soon as possible to prevent blindness.


When diagnosing ulcerative keratitis, an optician would use a fluorescein eye stain where he/she would use orange dye on blotting paper to see whether an ulcer shows on the cornea. If a corneal ulcer is found, the eye would be numbed and the ulcer scraped off to determine if it is fungal or bacterial.


Once the ulcer has been classified, medication would be prescribed to treat the underlying problem.


If it is a severe case of ulcerative keratitis, then a corneal transplant may be required. This is where the corneal tissue is surgically removed and replaced with donor tissue.


Ulcerative keratitis is a treatable disease and most people recover well. But a reduction in sight can occur and some people may also have permanent scarring on the eye.

Ureteric Implant

Some children are born with their ureters not joining the bladder in the correct place which can cause a condition called vesio-ureteric relux (VUR).


This can cause the valves to fail, allowing urine to flow backwards from the bladder to the kidneys, which can cause kidney failure.


The ureteric implant operation involves disconnecting the ureters and re-attaching them to the bladder in the correct place.

The end of the urecters joining the bladder are surrounded by muscle to strengthen the valves to reduce the chance of backwards flow again.


A catheter is often inserted into the bladder after the procedure to help drain the urine during the healing process.


Common problems after surgery can include blood in the urine, bladder spasms and cramping.

Sometimes children can suffer from a high temperature or intolerance to liquids after surgery. Children can still be prone to urinary tract infections after a ureteric implant.

Uterine Prolapse

This occurs when the pelvic floor muscles stretch and weaken so there is inadequate support for the uterus, meaning it slips down and protrudes out of the vagina.


Symptoms of a uterine prolapse can include; pain during sex, problems passing urine and the need to urinate more often. However, some women do not have any symptoms.


Childbirth through vaginal delivery can be a cause of a uterine prolapse. The risk of a woman having a prolapse increases as she gets older due to the lack of oestrogen hormone during menopause.


Treatment for a uterine prolapse is not always necessary, however, doctors may advise weight loss to ease stress on pelvic structures and avoiding heavy lifting. Pelvic floor exercises can strengthen the muscles.


If surgery is needed, then a hysterectomy may be performed, whereby the uterus is removed entirely. Or the uterus may be placed back in its original position by re-attaching pelvic ligaments.

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