Objective: To evaluate our unit’s theatre throughput efficiency, to identify where inefficiencies existed and consequently where the greatest improvement might be made.To identify the causes of day of surgery cancellations and how they might be avoided.  Patients and Methods: A prospective audit of theatre utilisation was undertaken over a 6 month period between 05/02//2013 and 02/08/2013 at Ipswich General Hospital, QLD, Australia.Times collected were: time of patient arrival in anaesthetic bay, start time of operative procedure, end time of operative procedure, and time of patient leaving theatre.The causative factors for any delays or day of surgery cancellations were identified and recorded where possible.  Results: In the six month period 26,850 sessional minutes were available for elective operating over 100 operating sessions.304 elective cases were performed, split between 21 major and 283 minor proceduresThe sessions ran overtime a cumulative 2114 minutes.Total non-operative minutes totalled 13,209 (50.3% of all available time), split between late starts 499 minutes (1.8%), early list finishes 1894 minutes (7.05%),  changeover time 1869 minutes (6.9%) and anaesthetic time, 8974 minutes (33.4%)Actual operating time only compromised 50.7% of all available elective operating session time (13,614 minutes)Theatre utilisation was 91.8%.51 procedures were cancelled on the day of surgery during the audit period, representing 14.3% of all scheduled procedures.The most common reason for cancellation was lack of surgical fitness, followed by inadequate operative time.  Conclusion:  A significant proportion of all elective operative time was consumed by non-operative minutes.Inefficiencies existed in turnover of patients as well as over as well as underbooking of patients on elective lists.An excessive number of cases were cancelled on the day of surgery, wasting valuable operative time.A multi-parametric approach must be taken to improve operation list utilisation.

Fig. 3. Intraoperative retrograde pyelogram showing a tortuous left ureter travelling inferiorly.

We report a case of visually impaired glaucoma patient with long term use of topical glaucoma medications presented with a corneal ulcer due to the improper technique of eye drop instillation. A 70-year-old gentleman with advanced primary open angle glaucoma (POAG) on his right eye and absolute glaucoma on his left eye, presented with painful redness and purulent discharge of the right eye for two weeks. He was using four types of topical glaucoma medication on his right eye since failed trabeculectomy two years ago. His right eye vision was 6/24 and painless blindness of the left eye before the presentation. He was administering all the medications himself despite his current vision status. Right eye examination showed visual acuity of 3/60 with clinical features of corneal ulcer. During the observation of his eye drop instillation technique, he consistently touched the tip of the bottle to his right cornea. The corneal contact area corresponded to the corneal ulcer area and size. In addition to this, the culture result obtained from both corneal ulcer and the bottles’ tips yielded similar microorganism which was Staphylococcus aureus. After an intensive course of topical antibiotics treatment, the corneal ulcer healed with a scar and the vision improved to 6/24 from 3/60. Although this incident is rare, it is crucial for the treating physicians to address the issue properly and co-manage these patients with pharmacists and nursing staffs as well as to seek support from the caretakers to prevent this blinding complication. KEYWORDS: corneal ulcer, glaucoma medication, eye drop instillation technique

Introduction The large nested variant of urothelial carcinoma (LNVUC) is a newly described and rare subtype of urothelial carcinoma. It is characterised by bland cytological features and a large nested architecture similar in appearance to low grade urothelial carcinoma with an inverted growth pattern. To date only 23 cases in a single series have been described. Case Report We describe the case of a 59 year old male with LNVUC whose tumour was initially misdiagnosed as a non-invasive low grade urothelial carcinoma. At a subsequent re-resection, his tumour was correctly re-classified as LNVUC with extensive invasion of the muscularis propria. Radical cystectomy and formation of an ileal conduit was performed. His operative specimen revealed invasion of prostatic stroma and perivesical fat, with all surgical margins clear. He is currently free from clinical recurrence 12 months after his cystectomy. Conclusion LNVUC is a newly described and rare urothelial carcinoma subtype. It characteristically possesses bland cytological features and may mimic low grade urothelial cancer. Despite its bland appearance it behaves aggressively with invasion, metastasis and death being common.

Introduction: Anchovy sauce is a known appetizer in many Asian's cuisines. Based on the bio-physical content of anchovy sauce, there is a possibility of the frequent consumption can affect severity and progression of glaucoma. The aim of this study was to determine the association of anchovy sauce intake in severity and progression of glaucoma. Methods: A cross-sectional study was conducted involving 91 primary glaucoma patients who were compliance and achieved target intraocular pressure, non-smoker and without a family history of glaucoma. Direct face-to-face interview on the dietary recall of anchovy sauce consumption was conducted between May 2013 and December 2013. The complete ocular examination was performed including intraocular pressure measurement. Hoddap-Parrish-Anderson criterion was used to assess the severity of glaucoma based on the latest reliable and reproducible of two consecutive Humphrey visual fields 24-2. The association between anchovy sauce and glaucoma severity was determined using Fisher's exact test. Multiple logistic regression analysis was performed to determine the association of anchovy sauce intake with glaucoma progression. Results: A total of 46 male and 45 female with primary glaucoma were recruited with a mean age of 66.4 (SD10.1) years old. 56 patients consumed anchovy sauce with 19% occasionally, 44.6% weekly, 16.1% daily and 5.4% in every meal. There was no significant association of anchovy sauce intake with severity and progression of primary glaucoma after a mean of 6.4 years of follow-up. Conclusion: Anchovy sauce has potential protective effect against progression and severity of glaucoma. However, it was not reflected in this study due to small sample size and poor quantification of the amount of anchovy sauce as a condiment to the main dish.