Nasal septum malignancies are highly treatable with good prognoses when in early stages. They required high degree of suspicion to be detected early. Treatment options include surgical resection and radiotherapy and they offered similar 3-year survival rate. Combined therapy is adopted in larger tumours; however, it is not verified with randomized trials. Vigilant follow-up is vital to detect early recurrence, which is common in advanced stage lesions.
Sham feeding following colorectal surgery is safe, results in small improvements in GI recovery, and is associated with a reduction in the length of hospital stay. It confers no advantage if patients are placed on a rapid postoperative feeding regime.
Mortality in patients following emergency laparotomy at Logan Hospital compares favourably with 11.1% reported by NELA. This may be partly attributable to case mix distribution as for each P-POSSUM risk Logan Hospital mortality was at the upper end of that reported by NELA. Further Australia data are required. Improved compliance with NELA recommendations may improve outcomes.
Background:Tracheostomies are commonly performed on critically ill patients requiring prolonged mechanical ventilation. The purpose of this study was to review our experience with surgical and percutaneous tracheostomies and identify factors affecting outcome.Materials and Methods:Patients who underwent tracheostomy between January 1999 and June 2008 were identified on the basis of Diagnostic Related Group coding and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification procedural code. The primary endpoint was in-hospital mortality. Contingency tables were generated for clinical variables and a chi-squared test was used to determine significance.Results:One hundred and sixty-eight patients underwent tracheostomy between January 1999 and 30 June 2008. In-hospital mortality was 22.6%. The probability of death was found to be independent of timing of tracheostomy, technique used (percutaneous vs. surgical), number of failed extubations and obesity. On univariate analysis, the null hypothesis of independence was rejected for age on admission (P = 0.014), diagnosis of sepsis (P = 0.0008) or cardiac arrest (P = 0.0016), Acute Physiology and Chronic Health Evaluation II score (P = 0.0319) and the Australasian Outcomes Research Tool for Intensive Care calculated risk of death (P = 0.0432).Conclusion:Although a number of patient factors are associated with worse outcome, tracheostomy appears to be a relatively safe technique in the Intensive Care Unit population.
A 75-year-old insulin-dependent type II diabetic male with a 9-month history of right eye diplopia, proptosis and reduced visual acuity (18/6) was referred by his general practitioner to the Ophthalmology Outpatient Department. A computed tomography (CT) of his orbits showed a well-defined 29 ¥ 20 ¥ 25 mm mass related to the mid portion of the right medial rectus muscle with displacement of the optic nerve laterally (Figs 1,2). Core biopsy of this lesion revealed a papillary carcinoma (Fig. 3a), immunoreactive to thyroid transcription factor 1, thyroglobulin and cytokeratin 7 (Fig. 3b). These features were consistent with a metastatic papillary carcinoma of the thyroid.A CT chest and abdominal scan demonstrated a 31 ¥ 39 ¥ 40 mm primary lesion in the left hemithyroid with retrosternal extension. There was mass effect resulting in right-sided tracheal shift and transverse compression. Multiple pulmonary nodules were also identified in conjunction with right hilar lymphadenopathy. Thyroid function showed mild hypothyroidism. He was staged VI C (T3 N1b M1) according to the AJCC classification. 1 The patient was discussed at the Multi-disciplinary Head and Neck meeting and the recommendation of the Clinic was that the patient be managed with a total thyroidectomy, neck dissection and adjuvant radioiodine ablation (RAI). Advice was sought from radiation oncology colleagues regarding preservation of the eye with either RAI or external beam radiation. Surgical exenteration was the preferred treatment option for the orbital metastasis as expert opinion felt that the non-surgical approach was unlikely to improve the patient's diplopia or visual acuity, and the patient was finding this extremely debilitating. It was hoped that the surgical resection of the orbital focus would also facilitate the uptake of RAI in the chest.A total thyroidectomy with neck dissection (left level II-V and VII) in conjunction with a right orbital exenteration was performed.Histology of the thyroid showed a widely invasive papillary carcinoma with lymphatic and skeletal muscle invasion. 5/5 lymph nodes identified in the central compartment (level 6), 4/13 lymph nodes in the level II-V neck dissection and both lymph nodes in level VII were positive for metastatic disease. The orbital exenteration had metastatic deposits of papillary carcinoma within the soft tissue; however, the globe and optic nerve were not involved.Post-operatively, the patient developed a chyle leak which required surgical exploration and thoracic duct ligation. The patient then underwent post-operative adjuvant RAI. This consisted of one dose of 4000 Mbq of I-131 and at this time his thyroglobulin was 910, anti-thyroglobulin antibody was negative, T4 3.2 and TSH 33. A post I-131 whole body scan showed no evidence of extracervical I-I31 avid thyroid metastasis.Metastases from papillary thyroid carcinoma (PTC) are observed rarely at the time of clinical presentation. The most common sites for metastases for PTC are the lungs and bone. 2,3 PTC rarely metastasizes to the orbit. ...
Background This study aimed to characterize the time‐dependent relationship between serum C‐reactive protein (CRP) and anastomotic integrity in the early post‐operative period and to develop a systematic use of CRP and computed tomography. Methods Patients aged 18 years or over who had the formation of a left‐sided colonic or a colorectal anastomosis, in Royal Sussex County Hospital, were included. The post‐operative day (POD) CRP cut‐off values were calculated according to receiver operating characteristic analysis to evaluate the sensitivities and specificities of the proposed cut‐off parameters. Results A total of 125 left‐sided colonic and colorectal anastomoses were recruited and analysed. When comparing to POD1 CRP cut‐off, the calculated CRP ratio cut‐off values of all the rest of PODs (2–5) were highly significant in the laparoscopic group and the overall group (P < 0.001). This statistically significant ratio was also demonstrated in the open group at POD2 (P < 0.0001). Conclusion CRP and CRP ratios cut‐off values were sensitive to detect an anastomotic leak in the early post‐operative period. The cut‐off values could facilitate the development of systematic use of CRP and computed tomography.
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