A 36-year-old man was referred to the general medical team with endophthalmitis. He was noted to have raised inflammatory markers and deranged liver function tests on admission. Subsequent abdominal ultrasound scan revealed a liver abscess requiring percutaneous drainage. A common human pathogen,Klebsiella pneumoniae, was cultured from multiple sites.K pneumoniaehas virulent serotypes (K1 and K2) that can cause primary liver abscess with metastatic infections. Cases have previously been predominantly reported in Southeast Asia but are increasing in prevalence in Europe and North America. The main known risk factor for the disease is diabetes mellitus. Swift antibiotic therapy, ophthalmology review and percutaneous drainage of any liver abscess are essential. Early recognition of the syndrome, despite potentially few initial symptoms, can significantly reduce morbidity and mortality. The authors report the first recorded case ofK pneumoniaeliver abscess with endophthalmitis in the UK.
Key Points: * Tranexamic acid is an antifibrinolytic agent that has been used in variety of operations to reduce blood loss. * Post thyroidectomy haematoma can be life threatening, therefore multiple methods are used to reduce the risk of bleeding. * Tranexamic acid was given intra-operatively to 106 patients undergoing thyroid surgery. * Patients who received tranexamic acid had no return to theatre for post-operative haematoma (p=0.041). * There were no adverse events reported related to the administration of tranexamic acid.Tranexamic acid use during thyroid surgery: A single centre retrospective analysis
Only four early years postgraduate surgical training posts in the UK meet nationally approved minimum quality standards. Specific recommendations are made to improve training in this cohort and to bolster recruitment and retention into Higher Surgical Training.
Approximately 20,000 adult and 25,000 paediatric tonsillectomies are performed each year in England. 0.9% of these patients return to theatre for post-tonsillectomy bleeding. The Royal College of Surgeons of England (RCSEng) have produced guidelines regarding emergency surgery, with standards for tonsillectomy discharge information. We audited our compliance with these guidelines and patient satisfaction regarding the information currently provided.Theatre records identified all tonsillectomies carried out between December 2012 and February 2013. 71 patients and their electronic discharge information were reviewed for post-operative bleeding information. Each patient was contacted, with a second call made to those who did not answer. 35 patients took part in our telephone questionnaire. Only 35% of patients had post-operative bleeding information on their discharge summary. 51% received no written information either in clinic or on the day of surgery, 66% recalled a verbal explanation. Only 54% knew to go to A&E if they experienced bleeding. 40% were not satisfied with their discharge information, stating that they wanted to know about bleeding, recovery expectations, and information regarding oral intake.A focus group was formed to discuss potential solutions to the audit outcomes and a tonsillectomy leaflet was produced inline with the trust patient information template. It contained specific instructions regarding bleeding and the nearest A&E contact details. It was reviewed by three tonsillectomy patients and their feedback regarding further information on post-operative diet, throat appearance and pain expectations was incorporated. A second cycle of the audit took place between August and September 2013. Results showed improvement, with 83% receiving an information leaflet and 100% a verbal explanation. 100% of patients were satisfied with their discharge information and 100% knew what to do if they bled. As a result we now meet the standards set out by the RCSEng and have increased our patient safety and satisfaction rates.
ProblemPatients undergoing tonsillectomies often have a limited amount of contact with an otolaryngologist. Once referred by their GP, they are likely to have one initial consultation prior to being listed for surgery. They are admitted on the day of their tonsillectomy and are often discharged the same day. This provides a limited amount of time in which the patient is able to both process the information given to them, as well as clarify any aspects of the procedure they are unclear about. As clinicians, with busy clinics and time pressures, we can also be guilty of under-explaining procedures and not giving enough space for the patient to ask any questions they might have.A key safety aspect of tonsillectomy discharge information regards what to do if the patient has bleeding post operatively. Postoperative bleeding can in the extremes be fatal, and therefore the importance of initial management by the patient should not be underestimated. Prompt presentation to an accident ...
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