Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low-or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.

Objective To review our experience in management of residual masses after chemotherapy for metastatic seminoma. Patients and methods The study comprised a review of 107 patients with metastatic seminoma, treated with initial chemotherapy from 1978 to 1996. Forty‐three patients had residual masses detected by computed tomography after chemotherapy, while 64 achieved a complete response. Residual masses were classified radiologically as <3 cm or ≥3 cm and as well‐ or poorly defined. Of the patients with residual masses, 19 underwent surgery, while 24 were observed. Results Viable cancer was present in six of 11 patients with well‐defined residual masses of ≥3 cm (positive histology in three of six undergoing surgery and site relapses in three of five observed), one of 14 patients with poorly defined masses of ≥3 cm (negative histology in nine undergoing surgery and site relapse in one of five observed), and in none of 17 patients with residual masses of <3 cm (negative histology in four undergoing surgery and no site relapses in 13 observed; one additional patient in this group died from treatment complications). Conclusion Patients with a complete response after chemotherapy, a residual mass of <3 cm and a poorly defined residual mass of ≥3 cm can be observed, reserving intervention for recurrent or progressive disease. Well‐defined residual masses of ≥3 cm should be resected because there is a 55% likelihood of persistent tumour.

(Fig. 1). A comparison of the postoperative radiographs Case reports of the three patients with the cadaveric dissections showed equivalent lead positioning (Fig. 2). Thus we Sacral nerve stimulators were implanted in 13 women; three experienced distressing sensory symptoms in the suggest that it is legitimate to draw inferences from the findings at dissection. Analysis of the prosected speciipsilateral lower limb which commenced immediately after implantation. These three patients complained of mens confirmed that a stimulating lead passed through the S3 foramen could lie close to the S3 nerve root. It severe, 'sciatica'-like pain, and one suCered loss of sensation to light touch in the foot. The last patient still was clear that this association becomes more intimate the more laterally in the S3 foramen the lead is placed takes regular analgesics 20 months after implantation. Another patient still complains of leg pain and continues (Fig. 3). An additional observation was the S3 dorsal ramus exiting the S3 foramen posteriorly in some of the to take analgesics intermittently 12 months after implantation. The third patient experienced leg pain for specimens. This small branch could possibly be damaged by the placement of a sacral lead in that foramen. 6 weeks after the operation, which then resolved. In all three patients the sensory symptoms persisted despite the temporary cessation of stimulation, suggesting that Comment the cause of the symptoms was not the stimulation.After a full neurological examination all three patients Neuromodulation of the sacral nerves by a permanently implanted sacral nerve stimulator has been shown to be underwent plain postero-anterior and lateral pelvic radiographs, and CT of the lumbosacral spine (MRI was an eCective therapy for treating various voiding disorders refractory to other treatment modalities [1][2][3] and it contraindicated because of the metallic implant). Clinical neurophysiological investigations included nerve conhas recently been granted a US Food and Drug Administration license for the treatment of urge duction studies, EMG sampling of lower limb muscles and tibial somatosensory evoked potentials. The radiographs confirmed the appropriate siting of electrodes according to the protocol. CT eliminated coexistent disk pathology in all three patients and the clinical neurophysiological investigations showed no abnormality; nerve conduction studies showed normal tibial motor conduction velocities, and 'F' waves recorded from flexor hallucis brevis were at a normal latency. The amplitudes of the sural and superficial peroneal nerve sensory action potentials were symmetrical between limbs. Concentric needle EMG sampling of L4-, L5-and S1-innervated muscles showed no evidence of denervation.To better understand the anatomical relationships of the sacral foraminal lead when implanted, two cadavers were dissected, in addition to studying prosected specimens at The Royal College of Surgeons of England, London. The cadaveric dissections showed that there is incontinence. ...

The purpose of this study was to evaluate patient selection, local control, survival and late toxicity of posthysterectomy adjuvant radiotherapy and compare adjuvant external beam therapy and high-dose rate (HDR) brachytherapy versus HDR brachytherapy alone. A retrospective analysis was performed on a series of 225 patients with endometrial cancer treated with external beam radiotherapy and HDR brachytherapy or HDR brachytherapy alone posthysterectomy from 1985 to June 1993. Of these 225 patients, 82 received external beam radiotherapy and brachytherapy and 143 received brachytherapy alone. The HDR fraction size was 8.5 Gy prescribed to the mucosal surface; two fractions were given after external beam and four fractions if brachytherapy alone was used. The median follow-up was 6.9 years. The patients who received combined external beam and brachytherapy had higher stage and grade tumors. The survival outcome was similar for either group when matched for stage. Overall relapse-free survival at five years was 96% and 81%, respectively for brachytherapy alone and combined adjuvant therapy. Pelvic recurrence was seen in 2.7% of patients. Toxicity was more common with external beam radiotherapy and brachytherapy compared to brachytherapy alone (45.1% vs 23.1%, P = 0.003). However, moderate or severe toxicity was rare but again was more common in the combined radiotherapy group (8.5% vs 2.1%, P = 0.04). There was a non-significant trend to increased toxicity after lymphadenectomy and external beam radiotherapy compared with patients who did not have a staging lymphadenectomy prior to external beam radiotherapy (62% vs 38%, P = 0.16). Adjuvant radiotherapy can be individualized and be based upon the information provided by the pathological specimens, which excluded external beam radiotherapy if a lymphadenectomy was performed and there was no evidence of extra-uterine disease. This study found more toxicity associated with adjuvant radiotherapy compared with other studies, but this may reflect different reporting criteria. There was more toxicity related to external beam radiotherapy and brachytherapy compared to brachytherapy alone. The two HDR brachytherapy protocols used in this series appear effective and safe.