Knee joint-position sensitivity has been shown to decline with increasing age, with much of the research reported in the literature investigating this age effect in non-weight-bearing (NWB) conditions. However, little data is available in the more functional position of weight-bearing conditions. The objective of this study was to identify the influence of age on the accuracy and nature of knee joint-position sense (JPS) in both full weight-bearing (FWB) and partial weight-bearing (PWB) conditions and to determine the effect of lower-extremity dominance on knee JPS. Sixty healthy subjects from three age groups (young: 20-35 years old, middle-aged: 40-55 years, and older: 60-75 years) were assessed. Tests were conducted on both the right and left legs to examine the ability of subjects to correctly reproduce knee angles in an active criterion-active repositioning paradigm. Knee angles were measured in degrees using an electromagnetic tracking device, Polhemus 3Space Fastrak, that detected positions of sensors placed on the test limb. Errors in FWB knee joint repositioning did not increase with age, but significant age-related increases in knee joint-repositioning error were found in PWB. It was found that elderly subjects tended to overshoot the criterion angle more often than subjects from the young and middle-aged groups. Subjects in all three age groups performed better in FWB than in PWB. Differences between the stance-dominant (STD) and skill-dominant (SKD) legs did not reach significance. Results demonstrated that for, normal pain-free individuals, there is no age-related decline in knee JPS in FWB, although an age effect does exist in PWB. This outcome challenges the current view that a generalised decline in knee joint proprioception occurs with age. In addition, lower-limb dominance is not a factor in acuity of knee JPS.

Backgrounds Bowel cancer is the second most common non‐cutaneous cancer diagnosed in Australia among both genders. Colonoscopy withdrawal time of at least 6 min has been accepted as the standard to achieve the target polyp detection rate (PDR) and adenoma detection rate (ADR). A retrospective review was conducted in Bundaberg Hospital to evaluate the relationship between colonoscopy withdrawal time against polyp, adenoma and cancer detection rates. Methods A retrospective study was carried out in Bundaberg Hospital on patients who had colonoscopies performed between 1 October 2016 and 30 September 2017 by the general surgical team. Data collection was conducted by reviewing patient charts, general practitioner referral letters and endoscopy reports. Statistical analysis was performed with chi‐squared test using Prism 8.2.1. Results A total of 1579 colonoscopies were analysed. The median age of patients undergoing a colonoscopy was 64 years (95% confidence interval (CI) 60.55–61.93). Median total duration of colonoscopy was 19 min (95% CI 20.9–22.0), with median withdrawal time of 9 min (95% CI 10.06–10.95). PDR, ADR and sessile serrated adenoma (SSA) detection rates were 43.3%, 33.1% and 5.4%, respectively. Cancer detection rate was 2.8%. Longer withdrawal times were associated with higher PDR, ADR and SSA detection rates (P < 0.0001) and higher mean number of polyp/adenoma/SSA detected. Conclusion Colonoscopies with withdrawal times of less than 6 min did not achieve the target detection rates. It is clear that achieving the advocated withdrawal time for screening colonoscopy improves detection rates.

Aim Appendiceal pseudomyxoma peritonei (PMP) is a rare entity, with recurrence rates up to 26% despite optimal cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Evidence specific to PMP originating from non‐infiltrative appendiceal mucinous neoplasms (low grade ‐ LAMN and high grade ‐ HAMN) is lacking. The aim of this study was to identify patterns of recurrence and predictive factors for patients appropriate for iterative surgery. Method A bi‐institutional retrospective analysis was performed on patients undergoing complete cytoreduction and HIPEC for PMP derived from perforated LAMN or HAMN. Multivariate logistic regression was performed to identify independent predictors for re‐do CRS. Five‐year overall survival (OS) was stratified according to surgical intervention, and 5‐year disease‐free survival (DFS) was stratified according to histological PMP grade. Cox regression analysis was performed to identify independent predictors for OS and DFS. Results Sixty of 239 (25.1%) patients developed peritoneal recurrence between 2007 and 2020. The median time to recurrence was 20.7 months. The risk of disease recurrence was highest with high‐grade PMP (P <0.001) and increasing PCI (P <0.001). Patients with high‐grade histology from their index procedure and aged over 60 years were less likely to be offered iterative surgery on multivariate analysis. Patients who underwent iterative CRS and HIPEC had a 5‐year survival of 100%. Conclusion Iterative CRS and HIPEC is feasible in selected patients with recurrent PMP, displaying good oncological outcomes. Age, index histology and level of abdominal quadrant involvement are predictive of proceeding to re‐do surgery.

knowledge, no series of patients with bilateral MCA occlusion has been published previously. Methods and Case ReportsNine of 1,377 patients from the EC/IC Bypass Study' were found to have bilateral occlusion of the MCA trunk, from the origin of the MCA to the origin of the first branch of trifurcation. To enter the EC/IC Bypass Study, all patients had to have had a TIA or a non-devastating stroke within three months of entry. In order to study only patients with atherosclerotic vascular disease, patients with severe strokes, fibromuscular dysplasia, arteritis, blood dyscrasia and heart disease as a source of cerebral emboli or decreased cerebral perfusion (valvular disease, atrial fibrillation and other major arrhythmia, cardiomyopathy) were excluded. The follow-up procedure included a neurological reevaluation every three months, with evaluation of delayed stroke, TIA, functional disability and death.

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Gastrosplenic fistula (GSF) is a very rare complication of several disease processes and can lead to catastrophic bleeding, necessitating emergent treatment. Splenic or gastric lymphomas are the predominant causes, with trauma and gastric surgery also implicated in several case reports. We present a case of a gastrosplenic fistula resulting from occlusion of the coeliac artery. To our knowledge, this is the first reported case of a GSF resulting from severe intra-abdominal arterial disease. A 60-year-old male initially presented to the emergency department with epigastric pain. He had an extensive medical history, including dialysis-dependent end-stage renal failure, atrial fibrillation, coronary artery disease, and multiple previous abdominal surgeries. Investigation with CT angiography revealed calcified occlusion of the coeliac artery as well as extensive calcification throughout his aorta and arterial tree. A diagnosis of mesenteric angina was made, but due to his poor functional status, he was not suitable for surgical or transcatheter interventions. He was treated symptomatically, but a month later developed sudden worsening of his epigastric pain, followed by large volume haematemesis. CT angiography showed a GSF with extensive gastric necrosis. Due to his poor functional status and rapid deterioration, he opted for palliation and passed away two days later. It has been postulated that GSF develops from the invasion of malignant tissue from the stomach to the spleen or vice versa, and subsequent necrosis of this tissue results in fistula formation. This case demonstrates that the invasion of an adjacent organ may not be necessary; necrosis itself can cause erosion that ultimately results in fistula formation.

A B S T R A C TBowel cancer is the second most common non-cutaneous cancer diagnosed in Australia in both the sexes.Australia has one of the highest incidence of bowel cancer in the world. Pyogenic liver abscess has been reported to be associated with malignancy especially hepatobiliary and colorectal cancer.A healthy 70 years old woman presented with non-specific symptoms which was initially thought to be secondary to haematological malignancy. Further investigation noted multiple large cystic and solid hepatic masses, which were suggestive of metastasis. However, hepatic lesions responded significantly with antibiotics which was in keeping with liver abscess instead. She was subsequently confirmed to have caecal adenocarcinoma with no distant metastasis.Although uncommon, pyogenic liver abscess can be the first presentation for colorectal malignancy.Colonoscopy is essential especially if no clear cause of liver abscess is identified.