Fluid overload is one of the major findings in patients with end-stage renal disease. Common findings in fluid overload include shortness of breath, pedal edema, ascites, and pericardial effusion. Rarely, vision loss can be associated with decompensated systemic fluid status. In the following case, we report an unusual case of vision loss due to retinal edema as a result of fluid overload diagnosed and followed to resolution by optical coherence tomography testing.
Background: Historic evidence suggests up to 16% (approximately) of non-visible haematuria (NVH) referrals result in Urological cancer diagnosis. The majority are bladder cancers, for which flexible cystoscopy is regarded the “gold standard” diagnostic procedure. Recent changes to suspected cancer referral guidelines, public information campaigns and reduced smoking prevalence may have changed this percentage. We retrospectively calculated cancer detection rates from NVH referrals to assess whether flexible cystoscopy,an invasive and morbid procedure, remains necessary.Patients and methods: All patients referred to our University teaching hospital on a suspected (“two-week”) cancer pathway with NVH over a 16-week period were included. Clinical and demographic data were collected for a series of 200 patients (96 male, age range 27–92, median 68).Results: Only eight patients had urological malignancy found (two renal and six bladder cancers). Both renal, and four bladder cancers, were identified on imaging prior to flexible cystoscopy. Only two bladder cancers were therefore detected by cystoscopy; one low-risk non-muscle invasive (patient has already been discharged) and one in a patient that was unfit for treatment (died of heart failure). Only seven (3.5%) of the patients were offered the option of not undergoing flexible cystoscopy.Conclusion: Our analyses suggest that flexible cystoscopy is rarely of benefit in patients with NVH. We suggest that patients should be given an accurate risk of bladder cancer diagnosis during the consent process. We advocate that flexible cystoscopy can be avoided for the majority of NVH referrals, particularly in patients without strong risk factors for urothelial cell carcinoma. Avoidance of flexible cystoscopy would reduce patient risks from procedural morbidity, reduce risks of acquiring coronavirus from hospital attendance, and there could be huge reductions in financial and service delivery demands in an overstretched secondary-care service.
Aims Levothyroxine (LT4) therapy is necessary post total thyroidectomy to suppress TSH for differentiated thyroid cancer (DTC) and euthyroidism for benign thyroid disorders. We aim to evaluate the accuracy of empirical LT4 regimens alongside existing formulas in literature and identify predictive variables for LT4 dosage. Methods Retrospective study between January 2018 to February 2021 for all total thyroidectomies at UHNM. Total 50 cases identified from central database for each group (DTC vs benign). Data collected and analysed including patient demographics, diagnosis, LT4 regimens and thyroid function. Results Most patients were started empirically on 125mcg/day LT4 (92% vs 90%, DTC vs benign). This led to 78% of DTC group and 82% of benign group being within 25mcg of the final LT4 regimen. For DTC thyroidectomies, comparing 125mcg/day versus recommended 2mcg/kg had an average error of -9.1% versus +26.1%. Correlation between Body Mass Index (BMI), Lean Body Mass (LBM) or Body Surface Area (BSA) to final LT4 was weak to moderate (r=0.4 p=0.002, r=0.6 p=<0.001, r=0.6 p=<0.001). For benign thyroidectomies, comparing 125mcg/day to BNF dose 1.6mcg/kg and formulas in literature resulted in average error ranging between -1.9% to +27.1%. The best average error was +0.2% using the formula 1.5mcg/kg by Jin et al. No correlation was found between BMI, LBM or BSA with final LT4 regimens (r=0.1 p=0.443, r=0.2 p=0.216, r=0.2 p=0.211). Conclusion In our subset, empirical dosing at 125mcg gives reasonable estimate of final LT4 dose. BMI, LBM or BSA alone was not a consistent predictor for final LT4 dose. Further validation of predictive formulas is needed.
Background The Covid-19 era has created a lot of uncertainty for management of common emergency and elective surgical conditions such as acute cholecystitis and other gallstone disease related emergency admissions. At our centre we continued to provide early operative intervention for patients presenting with biliary disease and acute cholecystitis throughout the Covid-19 era during both the 1st and the 2nd waves, despite a significant local surge in Covid-19 hospital admissions impacting on the available resources. Here we present the outcomes of our experience of managing such patients during the Covid-19 pandemic of 2020 of both 1st and 2nd waves. Methods A retrospective observational study was performed on all patients presenting with acute cholecystitis and biliary disease who underwent elective and emergency surgical intervention at UHNM (University Hospital of North Midlands) during the second wave of the Covid pandemic (2nd CW) between 14/10/2020 and 14/01/2021). These were then compared with patients who presented in the first Covid wave (1st CW) of 1/03/020 – 30/06/2020,) and a control group pre-covid (CG) 1/03/2019 – 30/06/2019, Patients were identified using ICD-10 codes K80 (Cholelithiasis) and K81 (Cholecystitis) and OPCS codes.J18.1 – J18.5. Primary endpoints were length of stay, 30 day readmission rates, mortality and morbidity. Results A total of 146 patients were identified who underwent laparoscopic cholecystectomy during the study time period (2ndCW). In comparison to 104 patients during the first covid wave cohort (1st CW) and the control group (CG) of 217 patients in the preceding non covid year. Length of stay (LOS) was significantly lower in the 2ndCW cohort in comparison to both the previous 1st CW cohort and the CG cohort (p < 0.0001), with readmissions also being statistically lower (5% vs 15% and 12% respectively p = 0.027). There was no statistical difference in outcomes for post-operative complications as per Clavien-Dindo classification. Conclusions Overall our study demonstrates that the recommended good practice of early surgical intervention in both emergency and elective gallstone disease can continue during the pandemic periods without any significant impact on patient care & outcomes. Also during this period length of stay was significantly shorted and lower 30 day readmission rates which are likely to be multifactorial but where lessons could be potentially learnt.
Background The COVID-19 pandemic has significantly impacted healthcare delivery globally with consequent restructuring of surgical services during the peak period and prioritisation of emergency and cancer surgery over elective operations. We present outcomes for laparoscopic cholecystectomy during the peak period for COVID-19 in the UK and compare this with data for the same period in 2019 Methodology This is a prospectively study. Analysis of collected data on patients who underwent laparoscopic cholecystectomy during the peak period for COVID-19 from 1st March 2020 – 30th June 2020 (study cohort) at the Royal Stoke University Hospital. Data from the same period in 2019 (control cohort) was compared and analysed. Results 104 patients underwent a laparoscopic cholecystectomy during the peak period compared to 217 during the same period in 2019. Median age in the study cohort was 51.5 years (15-84 years) and 52 years (19-91 years) in the control cohort (p = 0.49). Male to Female ratio was 1:2 in the study cohort and 1:2.2 in the control cohort (p = 0.67) Emergency admissions constituted the majority of cases and there was no statistically significant difference between both groups (61.5% vs 61.8%, p = 0.49). Most cholecystectomies were for biliary colic (41.3% vs 35.5%) and cholecystitis (37.5% vs 43.8%), and there was no statistically significant difference between both groups (p = 0.31 and p = 0.29 respectively). Conclusion This study demonstrates that laparoscopic cholecystectomy was feasible and safe in patients with symptomatic gall bladder disease during the peak period for COVID-19 when compared to a historic cohort in 2019.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.