HighlightsMidgut volvulus secondary to intestinal malrotation is a rare cause of acute abdomen in adults.There are only 92 reported cases in the literature.Diagnosis of the midgut volvulus was predominantly made via CT (67%) but also by ultrasound (15%) and theatre (18%).Midgut volvulus is associated with a high risk of ischaemia and necrosis of bowel supplied by the SMA (35).There is a 5% associated mortality rate.
Close monitoring of the patient's general condition in cases of non-specific abdominal pain is essential to identify the rare deteriorating patient for early surgical intervention and optimal outcome.
To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.
Introduction
Patients with blunt chest wall injuries often have severe associated injuries and even isolated chest injuries may have a high mortality and morbidity. The National Audit Office (2010) report estimated that there are 20,000 cases of major trauma per year in England; 5,400 people die of their injuries with many others sustaining permanent disability.
Aim
To assess compliance with trust guidelines for chest trauma pathway and the impact of poorly controlled pain on hospital acquired pneumonia (HAP) rate and hospital admission length
Method
A retrospective audit of all chest trauma between October 2019 to February 2020. Data obtained from electronic patient records and admission notes. Patients notes and imaging records are used to analyse adequate pain control based on local chest trauma pathways.
Results
28 patients identified (M:F 15:13) aged 47-94 yrs old (average age 73) who suffered from chest trauma in a district general hospital in England. Chest trauma was associated with high levels of morbidity (32%) and mortality (7%). 39% of patients were found to have inadequate pain control based on the local chest trauma pathway. 33% of chest trauma patients developed a HAP and 44% of pts with inadequate pain control developed a HAP. The admission length of patients with HAP secondary to chest trauma was on average three times longer relative to uncomplicated patients (15 days vs 5 days).
Conclusions
Chest trauma patients often receive inadequate pain control and delayed specialist team input. This results in an increase in the frequency of HAPs and admission length.
IntroductionIncidence of urolithiasis is rising worldwide and increasingly Ureteroscopy (URS) coupled with laser fragmentation is being used safely within the day surgery setting for ureteral and renal stone management. This study is to explore whether URS guided lithotripsy could be delivered effectively as a day surgery procedure.
MethodRetrospective analysis of 118 day surgery patients who underwent URS guided laser lithotripsy for ureteric and renal calculi between November 2017 and April 2019. All patients underwent ureteric stenting during acute admission prior to the URS guided lithotripsy. Outcomes were compared against European Association of Urology (EAU) guidelines on the best clinical practice in use of URS in urolithiasis.
ResultsOf the 118 patients who underwent URS and laser fragmentation, mean age was 54 years with 2:1 male:female ratio. 56% were ureteric (67% upper, 8% middle and 25% distal ureter), 44% renal stones. Mean stone size was 9.7mm, with 58% ‹1cm, 38% 1-2cm and 4% ›2cm. 90.6% of patients following URS guided stone fragmentation were stone-free. The complication rate was 8.5% (n = 10), Clavien-dindo 3 in 4 patients and Clavien-dindo 4 in 1 patient.
ConclusionThis study demonstrated that URS guided stone fragmentation can safely deliver high stone free and low complication rates within day surgery setting.
Introduction
Royal College of Pathologists (RCPath) published guidance on clinical information needed on histopathology forms accompanying colorectal cancer specimens. Inadequate information can significantly impact the ability of histopathologists to accurately interpret specimens; in turn correctly diagnose and stage cancers. The primary aim of our audit was to evaluate local compliance with the RCPath guidelines.
Method
Histopathology request forms of 50 patients undergoing anterior resections between January 2018-19 were retrospectively evaluated against the RCPath guidelines, ‘Standards and datasets for reporting cancers’ published in December 2017.
Results
Of the 50 patients, the site and type of tumour resection were documented in 94% and 56% of cases, respectively. 48% of cases specified whether the surgery was open or laparoscopic. However only 4% mentioned the preoperative tumour stage, and only 10% recorded whether any pre-operative therapy had been given. Furthermore, no cases reported whether there was a family history of bowel cancer or inflammatory bowel disease.
Conclusions
Information on colorectal histopathology forms is failing to meet RCPath guidelines. Significant information regarding preoperative treatment, associated malignancy risk factors and resection type is absent in over half of cases. This will have detrimental effects on the ability of histopathologists to accurately assess and interpret cancer specimens.
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