BACKGROUND Colorectal adenocarcinoma is the third most common cancer worldwide. It accounts for almost 10% of all cancer-related deaths. Skeletal muscle is a very unusual site for metastasis from colorectal cancers and is associated with a poor prognosis and high mortality. AIM To review the literature for cases of skeletal muscle metastasis (SMM) from colorectal adenocarcinoma. METHODS A systematic literature search using a validated search strategy was carried out to identify the incidence of SMM associated with colorectal adenocarcinoma. The studies identified were tabulated in a PRISMA, and data was extracted in a tabulated form. RESULTS Twenty-nine studies were included in this literature review. SMM was most commonly detected in the thigh muscles. Most of the tumours had originated from the rectum or the right colon. The histopathology of the primary tumour was generally advanced. The mean time interval between the primary tumour and onset of SMM was 22 mo. In 3 cases, asymptomatic SMM had been picked up by advanced imaging systems, like fluorodeoxyglucose-positron emission tomography scan. CONCLUSION SMM from colorectal adenocarcinomas is a rare complication. However, it is possible that the low incidence could be due to under-reporting. Early use of advanced imaging techniques and a high index of clinical suspicion might increase the reporting of SMM from colorectal adenocarcinoma.
Aim The office of national statistics (ONS) has estimated that around 5.8 million people are currently, waiting for treatment and the government has allocated £ 1.5 billion to tackle the backlog. The study aimed to analyze the likely effectiveness of these measures. Methods We looked at various government and NHS resources pertaining to the recovery plan. Results The actual numbers currently waiting to be treated is predicted to be closer to 13 million. Working within the current timeframes it will take up to 12 years to clear this backlog. Among the surgical specialities the numbers waiting are Orthopaedics- 700,547, Ophthalmology - 595,824, ENT - 459,087, Gynaecology - 438,703, General Surgery - 409,823. The £1.5 billion for elective recovery, includes £500 million capital funding (£250 million for increasing operating theatre capacity and hospital productivity and £250 million for an elective recovery technology fund). The private setup has been utilized in fits and starts to ensure there is no undue delay for cancer surgeries. Pop up centers and surgical hubs are to speed up the diagnosis and treatments for things like day case cataract surgeries. Conclusion Without disruptive thinking, clearing the backlog is mission impossible. The existing capacity has to be utilized beyond the conventional working hours and Hospital at weekend has to designated for pandemic backlog. This will give 104 additional full time days in each of the NHS Hospitals and paying the staff a “new pandemic bank rate” may help get the job done in 4–5 years. References 1. https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2021-22/; 2. https://www.ons.gov.uk/search?q=nhs+waiting+lists; 3. https://committees.parliament.uk/publications/8352/documents/85020/default/; 4. https://nhswaitlist.lcp.uk.com/; 5. https://ifs.org.uk/publications/15557
Aim In October 2020, the NHS committed to become the world's first carbon net-zero National Health Service by 2045. The aim of the study was to see what is Surgeon's role towards sustainability. Methods To review the Sustainable NHS with target of Net zero NHS proposal and analyse the changes being implemented at national and regional level. To assess how the surgical practice needs to contribute. Results Operating theatres contribute 30% of hospitals carbon footprint as the NHS contributes to nearly 5% of the country's carbon emissions. Exhaled anaesthetic gases are major contributors to the greenhouse effect and account for 5% of NHS foot print. Switch to more renewable sources of energy, to LED lights will offset some of that as will local products in the Supply chains. In theatres abandoning the use of single use plastics and switching to reusable instruments, as well as water free hand washes will help. Blue-zone technologies’ that capture, reclaim and purify halogenated agents should become a standard practice. Record of daily theatre waste is not being recorded. Optimal use of video technology for remote clinics and providing diagnostics and some interventions at non hospital sites will decrease patients need to travel and their carbon footprint. Conclusions There is need to accelerate awareness and encourage surgical care groups to change practice. Green sustainable theatres have to be standard in all new builds. Specialty specific, theatre waste analysis reports need to be presented in Monthly audits. Reference 1. https://www.gov.uk/government/news/uk-health-services-make-landmark-pledge-to-achieve-net-zero
Introduction Colorectal carcinoma is one of the most commonly diagnosed cancers. Metastasis is seen in the liver, lung, peritonium and bone. Though skeletal muscles make up a majority of our body mass, they are an extremely rare site for metastasis A 74 y/male known to have total ulcerative colitis was put on the 2WW due to change in bowel habits, weight loss and anemia. Investigations revealed a large cavitating lesion in the right colon with no evidence of metastasis. He underwent an open total pan procto-colectomy, small bowel resection and end ileostomy Histopathology showed the tumour was a completely excised adenocarcinoma During surveillance it was noted his CEA levels were high, for which he had a host of investigations including a CT scan and a PET scan, all of which had no interval changes. He mentioned that he noticed a lump in his left thigh. Orthopedicians advised an MRI scan which showed a tissue lump covering the front of the thigh, within the vastus medialis. A biopsy revealed metastatic adenocarcinoma. He also had left wrist pain. A thorough examination revealed a hard mass within the swelling. Ultrasound confirmed a solid well circumscribed mass with vascularity. Given the above information the patient felt he would be like to complete the remaining of his life with dignity and comfort at home and was fast-track discharged. Discussion Skeletal muscle metastasis of colorectal cancers is always associated with a prognosis that is somber and terminal. A high degree of suspicion is needed for diagnosis.
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