A total of 519 patients presenting with carcinoma of the caecum in the Plymouth Health District between 1975 and 1987 were reviewed. The clinical course was determined in relation to patients with and without a history of previous appendicectomy. There was no difference in the incidence of previous appendicectomy between patients with carcinoma of the caecum and an age and sex matched control group. The presence of synchronous carcinomas and/or adenomas was unrelated to previous appendicectomy. Ten patients presented with appendicitis and 11 with a mucocele of the appendix as the first sign of carcinoma of the caecum. Previous appendicectomy was associated with a higher incidence of local fixity, invasion of the abdominal wall, metastatic spread and poor differentiation. These differences were reflected in a significantly lower resection rate for carcinomas in patients who had previously undergone appendicectomy. The survival of patients who had previously had appendicectomy was significantly reduced. Four independent prognostic factors for survival were identified using multivariate discriminant analysis. These were Dukes' classification, local invasion, tumour differentiation and previous appendicectomy. Local recurrence was more common in patients who had previously had appendicectomy and was often in the old appendicectomy wound itself. Appendicectomy does not increase the risk of carcinogenesis in the caecum. In this study a history of appendicectomy was an independent risk factor for survival and significantly worsened the prognosis for patients who subsequently developed carcinoma of the caecum.
BackgroundThe re-engineering of emergency department (ED) processes in the UK since 2002 has produced significant reductions in waiting times.AimsWe aim to describe the generic themes contributory to this improvement in performance, which has led to progress not yet replicated elsewhere in the English-speaking world.MethodsWe reviewed the Emergency Services Collaborative (ESC) set up by the National Health Service (NHS) Modernisation Agency as well as our own departmental performance in order to identify key themes for discussion. In addition, we reviewed relevant information from the UK Department of Health website. We used the 4-h target of patient passage through the ED as our primary outcome measure.ResultsEarly results from the ESC showed improvements, which have been sustained and enhanced since inception. We use our hospital performance figures to demonstrate a pattern of progressive improvement in performance, with 99.1% of all new attenders in 2007–2008 being seen, treated and discharged or admitted within 4 h of presentation to the ED.ConclusionsThe whole systems approach to re-engineering emergency care has led to universal improvements in patient throughput in EDs in the UK. Several of the concepts found to be useful in the NHS are worthy of consideration and adoption by other health care systems. Long waits in the ED are a thing of the past in the UK.
Most circumcisions take place for religious rather than medical reasons. Geoff Hinchley argues that the practice is harmful and should be stopped but Kirsten Patrick believes that the future sexual health benefits justify parental choice
Indwelling shunts to divert CSF flow are essential in treating hydrocephalus. There is a high incidence of shunt malfunction, which accounts for the increasing popularity of endoscopic third ventriculostomy. Failure to recognize and act on symptoms and signs of shunt malfunction may lead to loss of life or to permanent neurological dysfunction. This review provides the basis for assessment and management based on updated clinical knowledge.
Urine testing for genital C trachomatis in the emergency department can identify asymptomatic men in the community who may otherwise remain undetected. It is suggested that this is a worthwhile screening test to offer in the emergency department, providing follow-up for treatment can be arranged locally. There is no requirement for increased emergency department input into these patients over and above introducing them to the screening programme.
SummaryTwo cases of emergency prehospital airway control using the laryngeal mask are described. The patients were trapped following road trafic accidents and limited access prevented tracheal intubation. The laryngeal mask airway may be a useful alternative to tracheal intubation in some cases of prehospital trauma care. Key wordsEquipment; laryngeal mask.The laryngeal mask was introduced by Brain in 1983 as a new item of equipment for the maintenance of the airway [I]. It can be inserted blind and may be used in spontaneously breathing patients or to permit intermittent positive pressure ventilation (IPPV). Although it is primarily used in routine anaesthesia [2] there have been reports of its use in emergency situations [3-51. We believe that these are the first case reports of the use of the laryngeal mask in prehospital trauma care. Case histories Case IA 21-year-old man was the front seat passenger in a car which suffered extensive front impact damage in a head-on collision. The driver was killed instantly. The patient was trapped in an upright position by his legs, pelvis and abdomen. He had a respiratory rate of less than 10 breath.min-', a weak pulse of 110 beat.min-I, and a Glasgow Coma Score of three. It was not possible to gain access to the patient in order to pass a tracheal tube. A laryngeal mask was passed from in front of the casualty, while his neck was supported in a cervical collar and assisted ventilation was successfully achieved using a bag attached to an oxygen reservoir. Following release of the patient, orotracheal intubation was attempted at the roadside but the vocal cords could not be visualised and there was considerable haemorrhage in the region of the posterior nasopharynx.A cricothyroidotomy was performed and the airway thereby secured and protected for transfer to hospital. This patient subsequently died from his thoracic and cerebral injuries. Patient 2A 32-year-old man was trapped by his lower limbs in a car. On examination, his airway was compromised by bleeding from severe facial fractures. His respiratory rate was 6 breath.min-I, his chest expansion was equal, he was pale and had a pulse rate of 120 beat.min-l. He was unresponsive to painful stimuli. Access to the casualty was limited by vehicle damage and attempts to control the airway and assist ventilation through an oropharyngeal airway using bag and mask technique were unsuccessful. A size 3 laryngeal mask was passed and artifical ventilation was successfully achieved. Intravenous fluids were administered and IPPV was continued during extrication of the patient, which took 30 min. Following release the patient's trachea was intubated at the roadside and he was transferred to hospital with controlled ventilation and a protected airway. After arrival in hospital he underwent emergency laparotomy and was found to have a severely lacerated liver. He died from overwhelming intra-abdominal haemorrhage which could not be controlled during surgery. DiscussionThe main objection to the use of the laryngeal mask in the emergency ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.