BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

To examine the incidence of haemorrhage following tonsillectomy, to explore the usefulness of antibiotic in preventing postoperative haemorrhage and to examine if the haemorrhage depended on the level of expertise of the surgeon. A retrospective review analysing tonsillectomy method, the rate secondary haemorrhage, the grade of operating surgeon. A v 2 analysis was used to determine the statistical difference between the haemorrhage rates of different tonsillectomy methods. One thousand three hundred and thirty-six tonsillectomies were performed during this period by four different methods: 615 by cold steel dissection, 582 by Coblation, 32 by bipolar dissection and 107 by Helica thermal coagulation. 621 tonsillectomies were performed by Consultant grade and middle grades performed 693 operations. 124 patients (9.3 %) were readmitted with haemorrhage. The secondary haemorrhage requiring surgery for controlling bleeding for cold steel dissection method was 1.5 % compared to 6.7 % for coblation method (P \ 0.01 %), 6.3 % for bipolar dissection and 1.9 % for Helica thermal coagulation method. Overall consultants had a post tonsillectomy haemorrhage rate of 5.5 % and middle grades had a rate of 3.7 %. 86.5 % of the patients were already on routine prophylactic oral antibiotics at the time of presentation with haemorrhage needing surgical arrest and 13.5 % were not on antibiotics (P \ 0.05 %). There was statistically significant difference in secondary haemorrhage rate between coblation and cold steel dissection methods. Coblation tonsillectomies had an increased need for operative intervention to control secondary haemorrhage. Routine use of antibiotic and expertise of operating surgeon had no bearing on secondary haemorrhage rate.

Background: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods: This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and intercentre variation in critical care admission after emergency laparotomy. Results: Of 4529 patients included, 37.8% (n¼1713) underwent planned critical care admissions from theatre. Some 3.1% (n¼86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n¼133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51e19.97) than planned admissions (OR: 2.32, 95% CI: 1.43e3.85). Some 26.7% of patients (n¼1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8e51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n¼10/145) of centres outside the 95% CI. Conclusions: After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Background: Thrombocytopenia is one of the most common causes of abnormal bleeding and is defined as platelet counts < 1.5 lakhs/cumm. Three processes can cause thrombocytopenia, namely: Deficient platelet production, accelerated platelet destruction, and abnormal pooling of the platelets within the body. Of these, accelerated platelet destruction is the most common cause for thrombocytopenia and has variety of etiologies. The usefulness of bone marrow analysis in assessing accelerated platelet destruction is still debated. Therefore, a new simple and non-invasive diagnostic approach for thrombocytopenia is needed. Aims and Objectives: The present study was done with an aim to evaluate the use of platelet indices, namely, mean platelet volume (MPV), Platelet Distribution Width (PDW), and Platelet Large Cell Ratio (P-LCR) in differentiating the various causes of hyperdestructive thrombocytopenia. Materials and Methods: This was a prospective study conducted over a period of 2 years and consisted of 206 cases of hyperdestructive thrombocytopenia. After recording relevant clinical details, platelet count along with platelet indices – MPV, PDW, and P-LCR was recorded. Based on the etiopathology identified, cases were categorized into three groups: Group I: Immunologic – cases of Immune thrombocytopenic purpura (ITP), Group II: Non-immune: Cases of sepsis and other non-immune causes of platelet destruction, and Group III: Viral and parasitic infections. Platelet indices were compared between the study groups and the control group which included 100 healthy individuals. Comparison was done among the three study groups as well. Results & Conclusions: Dengue accounted for the highest number of 131 (89.72%) cases in the study. MPV, PDW, and P-LCR were significantly higher (P < 0.0001) when compared to the healthy controls except P-LCR in Group II. A statistically significant increase in MPV was noted among ITP cases when compared to other causes of thrombocytopenia. There wa

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Liesegang rings (LRs) are benign and concentric non-cellular lamellar structures, occasionally found in kidney, synovium, conjunctiva, and eyelid. They are uncommon pathological findings which may cause diagnostic dilemmas for pathologists. We report a rare case of a 40-year-old female patient presenting with the left-sided lumbar pain, burning micturition, and hematuria for 1 week. With the radiological impression of a renal tumor, she underwent left radical nephrectomy. A diagnosis of clear cell renal cell carcinoma, the WHO/ISUP Grade II, and a stage of pT2aNxMx was made. An additional feature noted was the presence of LRs at the periphery of the tumor. It is important to recognize these rings to avoid mistaking them with parasites and dystrophic calcification. Hence, awareness among pathologists about these lesions would help in the proper management of the patients.

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Synovial sarcoma is a malignant soft tissue neoplasm which amounts to 7-10% of all sarcomas. Clinicopathological heterogeneity within this tumour creates a diagnostic challenge in sorting it out from its differential diagnoses. Here we report a 42-year-old female patient presenting with a mass in the right nasal cavity for two months. With an imaging impression of a right ethmoidal polyp with a remote possibility of malignant etiology, a final diagnosis of sinonasal synovial sarcoma was made with the help of a panel of IHC antibodies. A high degree of suspicion along with a detailed work up is required to accurately diagnose synovial sarcoma in unlikely locations such as nasal cavity. Keywords: Synovial sarcoma, Nasal cavity, TLE­1, BCL2, SOX 10