titles marked with an asterisk were judged for the RACS Prize for the best paper from a Trainee. Titles marked with a double asterisk were judged for the Bard Australia Prize for the best paper from a Trainee in hernia management. GS01HERNIA REPAIR: ARE WE THERE YET? M. Mccallum Newcastle, New South WalesHerniae have been documented since ancient times, but the era of modern hernia treatment is accepted as starting with the surgery of Bassini. Suture repairs of various types then dominated the treatment of hernia until the era of mesh repair championed by Stoppa and Lichtenstein.Surgeons feel that mesh repairs have revolutionized hernia surgery. Have the mesh repairs really made such a difference? There is evidence that all is not as it seems! Published recurrence figures don't seem to withstand close scrutiny.One of the trendy terms in herniology is the "myo-pectineal orifice", while many hernia specialists pay lip service to this concept, very few available hernia operations address this problem.The latest area of interest in the world of hernia surgery is the area of posthernia groin pain, either neuralgic or non-neuralgic. There are studies showing an incidence of chronic groin pain following anterior repairs of 30% or more, and yet these operations are the most common hernia operations in the world! Keith in 1924 first postulated the concept of herniosis and was criticized. However there is a large volume of convincing evidence that herniae are manifestations of a metabolic disorder. They are associated with abdominal aortic aneurysm and possibly with such diverse conditions as diverticular disease, cholelithiasis, and perhaps haemorrhoidal disease.Are we there yet? The answer is certainly no. However research into the metabolic problem of hernia development means that we are surely closer than we have ever been before.Purpose: Inguinal hernia repair is a common operation with much focus in recent times on improving morbidity. The use of mesh repair has greatly decreased reoccurrence rates and focus turns towards improving postoperative groin pain. This review examines the use of UHS in inguinal hernia repair and relation with postoperative groin pain. Methods: A retrospective audit of consecutive cases over one year (telephone and mailed questionnaires) was conducted. The recently validated IPQ (inguinal pain score) was used. A review of files and operative reports was also undertaken. Cases undergoing bilateral repair, or other operations simultaneously were excluded. Results: 59 patients (61%) participated in the audit, with a mean follow up of 11 months (range 5-16). 4 minor wound complications occurred. Higher pain scores appeared to correlate preoperatively with age and workers compensation status. Postoperative pain scores and limitation to functional status were low, and trended towards lower values in the UHS (ultrapro hernia system) repair group compared to the group who underwent repair with PHS (preceding week pain scores respectively -UHS repair, mean 1.22, (95%CI 1.07-1.38); PHS 1.76, (95%CI 1....
Background: Limited recent data exists regarding discospondylitis in dogs.Hypothesis/Objectives: (i) Describe the signalment, clinical and imaging findings, etiologic agents, treatment, and outcome of dogs with discospondylitis, (ii) determine diagnostic agreement between radiographs, CT, and MRI with regard to the presence of discospondylitis and its location, and (iii) determine risk factors for relapse and progressive neurological deterioration.Animals: Three hundred eighty-six dogs.Methods: Multi-institutional retrospective study. Data extracted from medical records were: signalment, clinical and examination findings, diagnostic results, treatments, complications, and outcome. Potential risk factors were recorded. Breed distribution was compared to a control group. Agreement between imaging modalities was assessed via Cohen's kappa statistic. Other analyses were performed on categorical data, using cross tabulations with chi-squared and Fisher's exact tests.Results: Male dogs were overrepresented (236/386 dogs). L7-S1 (97/386 dogs) was the most common site. Staphylococcus species (23/38 positive blood cultures) were prevalent. There was a fair agreement (κ = 0.22) between radiographs and CT, but a poor agreement (κ = 0.05) between radiographs and MRI with regard to evidence of discospondylitis. There was good agreement between imaging modalities regarding location of disease. Trauma was associated with an increased risk of relapse (P = .01, OR: 9.0, 95% CI: 2.2-37.0). Prior steroid therapy was associated with an increased risk of progressive neurological dysfunction (P = .04, OR: 4.7, 95% CI: 1.2-18.6).
IntroductionA 45-year-old man presented with a 2-day history of jaundice and severe epigastric pain radiating through to his back. He also complained of nausea and vomiting. He noted his urine to be dark and his stools pale but denied having pruritis. He drank 30 units of alcohol a week and had returned from mainland Spain 5 days prior to his illness. There was no previous history of jaundice or additional risk factors for chronic liver disease. He was on no regular medications. His only significant past medical history was a laparoscopic cholecystectomy performed 8 months previously due to an attack of cholecystitis.MethodsInitial blood tests demonstrated a mildly raised bilirubin and amylase but a marked transaminitis (ALT 2073 iu/l, normal range 0–35 iu/l). Twenty-four hours after admission he deterioratd with sepsis, renal failure, thrombocytopaenia and a microangiopathic anaemia. Imaging demonstrated common bile duct stones causing biliary obstruction and pancreatic inflammation. He was treated for his microangiopathic anaemia and as part the management of pancreatitis underwent an early therapeutic ERCP to provide biliary drainage.ResultsThe prevalence of common bile duct stones (CBDS) in patients with symptomatic gallstones is quoted to lie between 10 and 20%.1 In patients who are not jaundiced and have a normal trans-abdominal ultrasound the prevalence is said to be <5%.2 The natural history of CBDS is not well understood but if they do become symptomatic the consequences are often serious. He was assessed as low risk for CBDS and as suggested by current BSG guidelines did not have any additional biliary imaging.3This patient had an atypical presentation of a relatively common condition and subsequently developed a very rare complication. He required a prolonged critical care admission to support the management of multi-organ failure, which involved the expertise of a closely coordinated multidisciplinary team.ConclusionThe traditional teaching that an ALT >1000 iu/is due to drugs, viral hepatitis or ischaemia is a good rule of thumb. However, it is not a “golden rule” and when the clinical picture does not fit, the differential diagnosis needs to be widened. This case highlights the difficulties, complexity and spectrum of clinical conditions which present with abnormal liver function tests.
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