BACKGROUND:Postoperative pain is common in hemorrhoidectomy patients. Local anesthetic given either as an intraoperative pudendal nerve block or as a local wound infiltration may help alleviate postoperative pain.OBJECTIVES: This study sought to determine whether the addition of an intraoperative pudendal nerve block to a perianal local wound infiltration and standardized analgesia regimen was superior to a perianal local wound infiltration and standardized analgesia regimen alone in reducing early postoperative pain following hemorrhoidectomy. The secondary objective was to measure differences between treatment groups in perceived perianal numbness, oral opioid requirements, and adverse events. DESIGN: This study was a prospective, single-blinded randomized controlled trial approved by the Eastern Health Human Research and Ethics Committee in Melbourne, Australia (registration number: E09/2014). SETTINGS: Patients were recruited across 3 Australian hospitals.PATIENTS: Eighty patients with symptomatic hemorrhoids requiring hemorrhoidectomy in colorectal surgical outpatient clinics were successfully recruited and enrolled in the study, with 1 patient later dropping out. INTERVENTION:Patients were randomly assigned to either the pudendal nerve block group or a control group. The pudendal nerve block group received 5 mL bupivacaine 0.5% with adrenaline 1:200,000 to both pudendal nerve trunks bilaterally. Both groups received 10 mL of the same local anesthetic injected into the posthemorrhoidectomy wound bed. MAIN OUTCOME MEASURES:Visual analogue scales were used to record patient pain scores. Dichotomous (yes/no) answers were recorded for secondary objectives.RESULTS: There were no significant differences in postoperative pain between groups at 4 hours, 8 hours, 12 hours, or 24 hours. Additionally, there were no significant differences between groups with respect to perceived perianal numbness, oral opioid usage or adverse events. LIMITATIONS:The authors recognize that without a nerve stimulator, an argument can be made that the pudendal nerve block was not actually achieved.

Fig. 3. Resection specimen of the mesenteric lymphangioma with a segment of jejunum. Ascaris worm is seen protruding from an enterotomy.

No abstract

Background: It has been suggested that Chinese patients with breast cancer present at a younger age compared to the general Australian population, with tumour pathological characteristics that carry less favourable outcomes. This study was aimed to investigate if a substantial difference in breast cancer subtypes exists between the Australian Chinese population and the general Australian population. Methods: All patients with breast cancer treated by two of the authors (consultant breast surgeons) at Eastern Health, Victoria between 2010 and 2016 were identified through the BreastSurgANZ Quality Audit database. Australian Chinese patients were further identified through outpatient records and registration information. Medical histories were examined to obtain patient demographics, tumour characteristics and outcome. Patient and tumour characteristics between the Australian Chinese population were then compared to the general Australian population. Results: A total of 97 Australian Chinese patients with breast cancer were identified out of 582 patients. Mean age at diagnosis was 56.7 years, approximately 6 years younger than the general Australian population. There was a statistically significant difference in incidence of Luminal A tumours with 25 patients (25.77%) from the Chinese group affected compared to 310 patients (63.92%) from the general group (P < 0.001). There was no significant difference in proportions of the other tumour subtypes between the two groups. Conclusion: Australian Chinese breast cancer patients present at a younger age compared to the general Australian population, with a smaller proportion of patients having Luminal A tumours.