This study compares the effects on the hypothalamo-pituitary adrenal (HPA) axis of two dosage schedules of hydrocortisone 17-butyrate and hydrocortisone ointments in 20 children suffering from eczema. Children with moderately extensive eczema received either 30 g of 0.1% hydrocortisone 17-butyrate or 30 g of 1% hydrocortisone ointment weekly for 4 weeks without occlusion. Children with extensive eczema received either 60 g of hydrocortisone 17-butyrate or 60 g of hydrocortisone weekly for 4 weeks. All four groups showed some clinical improvement. Although many of the children appeared to have some impairment of adrenal function prior to entering the trial, no further significant depression of the HPA axis as reflected by the plasma ACTH levels and a 30-min Synacthen test was observed during the trial. On the basis of 4 weeks’ treatment, hydrocortisone 17-butyrate did not have a significantly different effect on the HPA axis in children from that of hydrocortisone.
AIMTo assess the impact of multi-disciplinary teams (MDTs) management in optimising the outcome for rectal cancers.METHODSWe undertook a retrospective review of a prospectively maintained database of patients with rectal cancers (defined as tumours ≤ 15 cm from anal verge) discussed at our MDT between Jan 2008 and Jan 2011. The data was validated against the national database to ensure completeness of dataset. The clinical course and follow-up data was validated using the institution’s electronic patient records. The data was analysed in terms of frequencies and percentages. Significance of any differences were analysed using χ2 test. A Kaplan-Meier analysis was performed for overall survival and disease free survival.RESULTSFollowing appropriate staging, one hundred and thirty-three patients were suitable for potentially curative resections. Seventy two (54%) were upper rectal cancer (URC) - tumour was > 6 cm from the anal verge and 61 (46%) were lower rectal cancers (LRC) - lower extent of the tumour was palpable ≤ 6 cm. Circumferential resection margin (CRM) appeared threatened on pre-operative MRI in 19/61 (31%) patients with LRC requiring neo-adjuvant therapy (NAT). Of the 133 resections, 118 (89%) were attempted laparoscopically (5% conversion rate). CRM was positive in 9 (6.7%) patients; Median lymph node harvest was 12 (2-37). Major complications occurred in 8 (6%) patients. Median follow-up was 53 mo (0-82). The 90-d mortality was 2 (1.5%). Over the follow-up period, disease related mortality was 11 (8.2%) and overall mortality was 39 (29.3%). Four (3%) patients had local recurrence and 22 (16.5%) patients had distant metastases.CONCLUSIONManagement of rectal cancers can be optimized with multi-disciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection.
The surgery was performed under general anaesthesia with the patient in the right lateral position. Five ports were used including the camera port. The positions of ports are shown in figure 2. No abnormality was evident in the peritoneal cavity. The stomach was lifted up using an instrument through the epigastric port. The gastrocolic omentum was divided. A pancreatic mass, involving the tail and compressing the splenic hilum was noted. The pancreas was retracted caudally; the splenic artery was dissected on its upper border and divided between clips. The splenocolic attachments were divided. The spleen was mobilised from its attachments to the diaphragm. The pancreas was lifted up and the splenic vein was identified and divided between clips. The pancreas was transected through the body using an ultrasonic dissector. The specimen was placed into a refashioned uribag and retrieved via a 5 cm mini incision
Congenital midline facial anomalies are a rare group of disorders that are often accompanied by a constellation of other clinical anomalies, many of which have been recognized as syndromes. The index case is a child with midline facial defect with cleft palate associated with ambiguous genitalia and an umbilical defect. Differential diagnoses including Holoprocencephaly (HPE), Midline facial Plane defect, Oral-facial Digital syndrome, and Kallmanns syndrome are discussed. Although the most probable diagnosis is HPE, ambiguous genitalia and umbilical deformity are atypical findings which merit special mention.
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