The limited evidence from the included trials suggests that SNS can improve continence in a proportion of patients with faecal incontinence. However, SNS did not improve symptoms in patients with constipation. In addition, adverse events occurred in some patients where these were reported. Rigorous high quality randomised trials are needed to allow the effects of SNS for these conditions to be assessed with more certainty.

Purpose. Tailgut cysts with malignant transformation are rare entities. We discuss the diagnostic strategy and treatment of a malignancy within a tailgut cyst. Methods. In this study we report on the case of a 61-year-old man with a malignant neuroendocrine tumour arising within a tailgut cyst and an overview of the literature emphasising the histopathological characteristics and differential diagnosis. Results. Our patient presented with lower back pain, rectal pain, and increased urgency of defecation. MRI scan and CT-guided biopsy on histological analysis revealed a diagnosis of carcinoid tumour of the presacral space. The patient subsequently underwent an abdominoperineal excision of the rectum. Conclusions. This case highlights the importance of tailgut cysts as a differential diagnosis of presacral masses. It is a rare congenital lesion developing from remnants of the embryonic postanal gut and is predominantly benign in nature. Approximately half of cases remain asymptomatic; therefore, diagnosis is often delayed. Magnetic resonance imaging is the investigation of choice and an awareness of the possibility of malignant potential is critical to avoiding missed diagnosis and subsequent morbidity. Complete surgical excision allows accurate diagnosis, confirmation of oncological clearance, and prevention of mortality.

PurposeAvailability of comorbidity assessment at multi-disciplinary team (MDT) discussions is cornerstone in making the MDT process more robust and decisive in optimising treatment and improving quality of survivorship. Comorbidity assessments using tools, such as the ACE-27 questionnaire would aid in optimising the decision-making process at MDTs so that treatment decisions can be made without delay. This study determined the availability of comorbidity data in a CRC MDT and the feasibility of routine comorbidity data collection using the validated ACE-27 questionnaire. Secondary aims determined the optimal time and method of collecting comorbidity data.MethodsA retrospective mapping exercise (phase I; 6-months) examined the availability of comorbidity data within the MDT. Phase II prospectively collected comorbidity data using ACE-27 for a 3-month period following a short pilot.ResultsIn phase I, 73/135 (54%) patients had comorbidity data readily available informing the MDT discussion; 62 patients lacked this information. After a review of the patient records, it was clear that 41 of these 62 also had comorbidities and 21 out of the 135 had ≥ 2 major system disorders. Common referral sources to the MDT were surgical outpatient clinics (42%) and the endoscopy unit (13%). The average lead-time from referral to MDT discussion was 14 days. In phase II, an ACE-27 questionnaire was prospectively administered in 50 patients, mean age 54 years (range 20–84). Male: female ratio 26:24. Average time to administer ACE-27 was 4.8 min (range 1–15).ConclusionsThe phase I study confirmed the widely acknowledged view of poor comorbidity data availability within a CRC MDT. Phase II demonstrated the feasibility of routinely collecting comorbidity data using ACE-27.

We present an unusual case of a 74-year-old woman who presented with a pseudoaneurysm at the site of a previous prosthetic femoro-popliteal bypass graft and underwent an urgent repair with pseudoaneurysm excision and extra-anatomic placement of an autologous venous graft. Microbiology examination revealed Aspergillus fumigatus infection of the graft, which is a very rare condition. Long-term antifungal medication has been administrated with positive outcome. Only a few cases have been reported in literature, mainly involving aortic grafts. Most patients are immunocompetent and with late presentation. Successful outcome can only be achieved with long-term antifungal treatment and extra-anatomic replacement of the graft.

A 77-year-old woman presented to the emergency department with a 1-week history of anorexia, fatigue, general malaise and a 3-day history of fever. Clinical examination revealed livedo reticularis across the anterior aspect of her knees and a pansystolic murmur. Laboratory evaluation found neutrophil leucocytosis; elevated C reactive protein and blood cultures grew Streptococcus acidominimus. Transthoracic echocardiography displayed vegetation on the mitral valve and a left atrial myxoma. She was treated with intravenous benzylpenicillin and erythromycin for the infective endocarditis (IE) and remains well 3 months post-treatment. S. acidominimus is considered a common veterinary pathogen rarely found in humans. To the best of our knowledge, only two prior reports of IE due to this organism exist in the literature. This case highlights how rare pathogens can cause unusual presentation and the importance of IE as a differential even in the absence of classical signs, if fever and new murmur are present.

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Background: Non-alcoholic liver disease (NAFLD) is among leading causes of chronic liver disease. Recent evidence suggests an association of NAFLD with cardiovascular diseases; however, few studies have analyzed national level database for this relationships. We aimed to assess the trends and predictors of acute myocardial infarction (AMI) among NAFLD patients in the United States. Methods: The National Inpatient Sample (NIS) database from 2016 to 2019 was queried using international classification of disease (ICD-10) diagnostic codes to identify patients with primary diagnosis of NAFLD and secondary diagnosis of AMI. Basic demographic variables were analyzed to determine the disparities in prevalence of AMI among NAFLD patients. Univariate logistic regression model was used to compare the odds of development of AMI among NAFLD patients using demographic characteristics. Multivariate logistic regression analysis was done to determine whether NAFLD is an independent predictor of AMI. Results: A total of 58,519 patients had a diagnosis of NAFLD and of these, 5,448 had AMI. Of these, 61% were males, 82% were aged 50 years and over, 68% were white, 8% Black, 16% Hispanic, Asian or Pacific Islander. Females were less likely to have AMI [OR 0.46, 95% CI 0.43-0.48]. Patients <50 years with NAFLD were less likely to develop AMI [OR 0.41, 95% CI 0.38-0.44]. Compared to the whites, blacks [OR 0.57, 95% CI 0.51-0.61, p< 0.001] were less likely to have AMI. However, Hispanics [OR 1.16, 95% CI 1.07-1.25, p< 0.001] and Asian and Pacific Islanders [OR 1.31, 95% CI 1.13-1.51, p< 0.001] were more likely to have AMI compared to the whites. On multivariate analysis, NAFLD was found to be an independent predictor of AMI [OR 1.55, 95% CI 1.51-1.60, p< 0.001] after controlling for sociodemographic variables such as age, sex, race, smoking status, insurance status, hospital location and teaching status, and clinical variables such as previous MI, Congestive heart failure, diabetes mellitus, chronic kidney disease, hyperlipidemia, and hypertension. Conclusions: This analysis suggests older white males with NAFLD had a higher prevalence of AMI and that NAFLD is an independent predictor of AMI.