The introduction of the AGSU unit led to a significant reduction in overnight operating, which may improve patient outcomes and surgeon satisfaction. Length of stay and time to theatre did not change. Future directions include further research into the impact of theatre access on emergency surgery outcomes.
Eighty-eight kidneys obtained at necropsy from normotensive subjects aged over 50 years were examined histologically and by post-mortem pyelography and angiography. Moderate or severe scarring was present in 50%. Its distribution and the absence of calyceal deformity make pyelonephritic scarrig unlikely. Its extent was related to the severity of change in the renal vessels, but not to age. On pyelograms, scarring was difficult to distinguish from fetal lobation. Kidneys with the most severe histological changes in the vessels tended to show the most marked angiographic distortion, though in general the two techniques examine different parts of the renal vascular bed. Total renal area and "cortical" area, measured from the angiograms, were not significantly correlated with age, thouth both tended to be smaller in older subjects. These dimensions, particularly cortical area, were significantly correlated with vascular changes, being smallest when vessels were most markedly affected. Results suggest that the loss of renal tissue which occurs in the elderly, particularly selective loss of cortex, is more closely related to events in the renal vasculature than to age itself.
Summary
Two patients with epithelioid haemangioendotheliomata of the liver are described. Both presented with abdominal pain and malaise, with hepatomegaly and a variable degree of hepatocellular dysfunction. Diagnosis was delayed in both cases, each patient undergoing a protracted series of investigations including repeated liver biopsies. The major obstacles to early diagnosis were a lack of clinical awareness of the condition and difficulties in interpretation of the liver histology: the widespread sclerosis in the tumour tissue is easily mistaken for a post-necrotic or cirrhotic process. The key to the diagnosis is the demonstration of cells containing Factor-VIII-related antigen confirming the endothelial origin of the tumour. One patient died within three months of presentation and the other after 18 months. The tumour may, therefore, be more aggressive than earlier reports seem to suggest. It seems likely that the tumour is being under-diagnosed and although no specific therapy has been shown to be of value, a greater awareness of the condition, resulting in a more prompt diagnosis, should save patients from undergoing unnecessary investigation.
Antioxidant therapy is thought to improve oocyte quality through the reduction of oxidative stress. Melatonin and coenzyme Q10 (CoQ10) are known antioxidants. We aimed to investigate the clinical efficacy of exogenous melatonin supplementation with or without CoQ10 in improving oocyte quantity and quality. Fifty-three women undergoing cycles at Monash IVF were supplemented with melatonin 4 mg daily, with 19 of those additionally supplemented with 150 mg of CoQ10. Controls were matched at a 2:1 ratio to cases. Data were taken from an index (pretherapy) cycle and from a therapeutic (posttherapy) cycle for both cases and controls. Comparisons were made directly between cases and controls in the therapeutic cycle and by comparing the median differences of the change in outcomes from the index to therapeutic cycle. Primary outcomes included follicle, oocyte, and metaphase II oocytes (MII) counts. Results showed higher median absolute oocyte numbers (6.00 vs. 4.00, P = 0.049) in the case group. Cases and controls were significantly different when comparing median change between cycles in oocyte number (0.00 vs. -1.00, P = 0.028) and MII count (0.00 vs. -1.00, P = 0.034). However, this was the result of poorer outcomes in the control group rather than improvements in the case group, and it cannot be concluded that treatment improved oocyte quality.
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