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Note Review (note + review)
Kinds of Note Review Selected AbstractsOlder patients and delayed discharge from hospitalHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2000Christina R. Victor BA M Phil PhD Hon MFPHM Abstract Older people (those aged 65 years and over) are the major users of health care services, especially acute hospital beds. Since the creation of the NHS there has been concern that older people inappropriately occupy acute hospital beds when their needs would be best served by other forms of care. Many factors have been associated with delayed discharge (age, sex, multiple pathology, dependency and administrative inefficiencies). However, many of these factors are interrelated (or confounded) and few studies have taken this into account. Using data from a large study of assessment of older patients upon discharge from hospital in England, this paper examines the extent of delayed discharge, and analyses the factors associated with such delays using a conceptual model of individual and organisational factors. Specifically, this paper evaluates the relative contribution of the following factors to the delayed discharge of older people from hospital: predisposing factors (such as age), enabling factors (availability of a family carer), vulnerability factors (dependency and multiple pathology), and organisational/administrative factors (referral for services, type of team undertaking assessments). The study was a retrospective patient case note review in three hospitals in England and included four hundred and fifty-six patients aged 75 years and over admitted from their own homes, and discharged from specialist elderly care wards. Of the 456 patients in the sample, 27% had a recorded delay in their discharge from hospital of three plus days. Multivariate statistical analysis revealed that three factors independently predicted delay in discharge: absence of a family carer, entry to a nursing/residential home, and discharge assessment team staffing. Delayed discharge was not related to the hypothesised vulnerability factors (multiple dependency and multiple pathology) nor to predisposing factors (such as age or whether the older person lived alone). The delayed discharge of older people from hospital is a topic of considerable policy relevance. Our study indicated that delay was independently related to two organisational issues. First, entry into long-term care entailed lengthy assessment procedures, uncertainty over who pays for this care, and waiting lists. Second, the nature of the team assessing people for discharge was associated with delay (the nurse-coordinated team made the fewest referrals for multidisciplinary assessments and had the longest delays). Additionally, the absence of a family carer was implicated in delay, which underlines the importance of family and friends in providing posthospital care and in maintaining older people in the community. Our study suggests that considerable delay in discharging older people from hospital originates from administrative/organisational issues; these were compounded by social services resource constraints. There is still much to be done therefore to improve coordination of care in order to provide a truly ,seamless service'. [source] National review of maternity care for women with HIV infectionHIV MEDICINE, Issue 5 2006C McDonald Objective To assess adherence to the British HIV Association (BHIVA) 2001 guidelines for the management of HIV-infected pregnant women. Methods A survey and a case note review were carried out using structured questionnaires sent to providers of adult HIV care in the UK and Ireland. Participants were women with HIV infection who delivered a live or stillborn infant between October 2002 and September 2003. The main outcome measures were the appropriate use of antiretroviral therapy, the use and timing of elective Caesarean section, and support for the avoidance of breast-feeding. Results Of 186 centres, 100 (54%) responded with data on 501 eligible pregnancies. Conclusions In general, practice was in accordance with the BHIVA 2001 guidelines. However, in a number of cases Caesarean sections were planned later than the recommended 38 weeks. [source] Does psychological counseling alter the natural history of inflammatory bowel disease?INFLAMMATORY BOWEL DISEASES, Issue 4 2010Mahmood Wahed MBBS Abstract Background: There is increasing evidence that psychological stress can increase mucosal inflammation and worsen the course of inflammatory bowel disease (IBD). We have now assessed whether psychotherapy by a counselor specially trained in the management of IBD can influence the course of disease. Methods: Using retrospective case note review, we compared the course of IBD in 24 patients (13 ulcerative colitis; 11 Crohn's disease), during the year before (year 1) and the year after referral (year 2) for supportive outpatient psychotherapy to an IBD counselor, to that of 24 IBD controls who were matched to individual cases for age, sex, disease, duration of disease, medication at baseline, and for relapse rate in year 1. Counselor assessments were made using a visual analog scale 0,6 (0 denotes poor, 6 excellent response to counseling). The results are shown as median (range). Results: Patients were referred for counseling because of disease-related stress (14 patients), work problems (3), concerns about surgery (5), and bereavement (2); they received 6 (1,13) 1-hour sessions in year 2. In the year after starting counseling (year 2), patients had fewer relapses (0 [0,2]) and outpatient attendances (3.5 [1,10]) than in the year before referral (year 1) (2 [0,5], P = 0.0008; and 6.5 [1,17], P = 0.0006, respectively; furthermore, steroid usage (1 course [0,4] before, 0 [0,2] after, P = 0.005) and relapse-related use of other IBD medications declined during psychotherapy (1 drug [0,5] before, 0 [0,2] after, P = 0.002). There were no differences in any of these measures between years 1 and 2 in the control group. Numbers of hospital admissions did not change between year 1 and 2 in either group. In the 20 patients who attended >1 session counseling helped solve stress-related difficulties (counselor's score 4 [3,5]), the counselor scored them 4 (3,6) overall in psychological well-being after the counseling sessions. Conclusions: IBD-focused counseling may improve not only psychological well-being, but also the course of IBD in individuals with psychosocial stress. (Inflamm Bowel Dis 2009;) [source] Inflammatory myositis in systemic sclerosis: a South Australian perspectiveINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2005T. Y.-T. Abstract Background:, Muscle atrophy and weakness occurs commonly in patients with systemic sclerosis, especially late in the course of the disease. However, profound proximal muscle weakness secondary to myositis is an infrequent finding. Aim:, To determine the frequency and disease characteristics of patients with myositis in our cohort of systemic sclerosis patients. Methods:, A retrospective case note review of the clinical course of all patients enrolled on the South Australian scleroderma register, a population-based register of 374 living and 234 deceased patients with systemic sclerosis, last updated to the end of December 2002. Results:, Twenty patients with myositis were identified, the majority with diffuse cutaneous systemic sclerosis and overlap syndromes. The calculated frequency of this complication was 3.3% in our population-based cohort. All patients suffered profound proximal muscle weakness complicated by functional impairment. Other clinical features included weakness of cervical musculature (15%), dyspnoea (10%) and dysphagia (10%). Creatine kinase level was elevated in 80% of the patients, with the mean peak creatine kinase level of 1129 U/L. When further investigations were undertaken, 80% of patients demonstrated myopathic changes on electromyography and 92% of patients were found to have histological findings characteristic of an inflammatory process. Positive antinuclear antibodies were identified in all patients, including two with anti-PM-Scl autoantibodies. Conclusion:, Myositis is an infrequent clinical feature in patients with systemic sclerosis. Profound proximal weakness in association with elevated creatine kinase levels and myopathic changes on electromyography should alert the clinician to this complication. The presence of anti-PM-Scl autoantibodies in association with overlap syndromes may have a more favourable prognostic significance. [source] Complications and diagnostic difficulties arising from biliary self-expanding metal stent insertion before definitive histological diagnosisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2008Lakshmana Ayaru Abstract Background:, Self-expanding metal bile duct stents provide good palliation for inoperable malignant disease. However, problems may arise if metal stents are inserted before definitive histological diagnosis. The aim of this study was to evaluate the outcome of such patients. Methods:, A retrospective case note review was conducted of patients referred to a tertiary pancreaticobiliary center between 1992 and 2004 in whom a metal bile duct stent was inserted for presumed unresectable malignant disease before definitive histological diagnosis. Results:, There were 21 patients identified. Final diagnoses were: group 1, benign disease (n = 3); group 2, resectable malignancy (n = 2); group 3, unresectable malignancy (n = 12); and group 4, diagnosis remains uncertain (n = 4). During a follow-up of 22, 38 and 111 months, the patients in group 1 had one, eight and five episodes of stent occlusion. In group 2, both patients underwent pancreaticoduodenectomy for ampullary carcinoma, 2 and 6 months after presentation. In group 3, the median time to a confirmed malignant diagnosis was 2 months (range 1,27 months). In group 4, a median of two biopsies (range 1,4) were negative for malignancy, during a median follow up of 13 months (range 3,46). Overall in eight patients, the metal stents caused artifacts on computed tomography and/or were associated with tissue in-growth making the differentiation between benign and malignant disease difficult. Conclusion:, These cases indicate that metal bile duct stent insertion before definitive histological diagnosis can be problematic. A proportion of cases will have benign strictures and in others the confirmation of malignancy may be made more difficult. [source] Nutritional factors associated with survival following enteral tube feeding in patients with motor neurone diseaseJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2010A. Rio Abstract Background: Motor neurone disease (MND) is a progressive neurodegenerative disease leading to limb weakness, wasting and respiratory failure. Prolonged poor nutritional intake causes fatigue, weight loss and malnutrition. Consequently, disease progression requires decisions to be made regarding enteral tube feeding. The present study aimed to investigate the survival, nutritional status and complications in patients with MND treated with enteral tube feeding. Methods: A retrospective case note review was performed to identify patients diagnosed with MND who were treated with enteral tube feeding. A total of 159 consecutive cases were identified suitable for analysis. Patients were treated with percutaneous endoscopic gastrostomy (PEG), radiologically inserted gastrostomy (RIG) or nasogastric feeding tube (NGT). Nutritional status was assessed by body mass index (BMI) and % weight loss (% WL). Serious complications arising from tube insertion and prescribed daily energy intake were both recorded. Results: Median survival from disease onset was 842 days [interquartile range (IQR) 573,1263]. Median time from disease onset to feeding tube was PEG 521 days (IQR 443,1032), RIG 633 days (IQR 496,1039) and NGT 427 days (IQR 77,781) (P = 0.28). Median survival from tube placement was PEG 200 (IQR 106,546) days, RIG 216 (IQR 83,383) days and NGT 28 (IQR 14,107) days. Survival between gastrostomy and NGT treated patients was significant (P , 0.001). Analysis of serious complications by nutritional status was BMI (P = 0.347) and % WL (P = 0.489). Conclusions: Nutritional factors associated with reduced survival were weight loss, malnutrition and severe dysphagia. Serious complications were not related to nutritional status but to method of tube insertion. There was no difference in survival between PEG and RIG treated patients. [source] Cap gun burns in childrenJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2007Deborah AE Maze Aim: To document the frequency of cap gun burns in children and identify strategies for prevention of this mechanism of injury. Methods: Retrospective case note review of children under 16 years of age treated at The Children's Hospital at Westmead between January 1999 and December 2004 with burns secondary to toy cap guns. Results: Five boys were treated over the 5-year study period. None was supervised at the time of injury and in three cases the caps appeared to explode with minimal handling. All burn wounds healed without operative intervention and only one child suffered permanent sequelae from the burn injury. Conclusion: Cap gun burns appear a rare mechanism of burn injury not previously reported. Recently produced caps may be more susceptible to spontaneous explosion. Adequate adult supervision may have prevented some of the injuries. There appears be a need for greater awareness regarding the dangers of these toys. [source] Transjugular intrahepatic portosystemic shunt: an analysis of outcomesANZ JOURNAL OF SURGERY, Issue 10 2009Timothy P. Kurmis Abstract Background:, Transjugular intrahepatic portosystemic shunts (TIPS) are utilized for the management of complications of portal hypertension, particularly diuretic-resistant ascites and recurrent variceal bleeding. It has also been applied in Budd,Chiari syndrome and hepatorenal syndrome. We report the results in a small series, over 9 years, from a single centre, and compare these to those published in the literature. Methods:, A retrospective case note review of 20 consecutive TIPS procedures performed at Flinders Medical Centre from January 1997 to December 2005 was completed. All indications were included in the analysis. Underlying liver disease, peri-procedure complications, relief of symptoms and patient survival were recorded. Data on type of TIPS, shunt patency and method of follow-up were recorded. Results:, Thirty-six TIPS were performed in 20 subjects. All initial TIPS attempts were successful. Indications were: refractory ascites (18), acute variceal bleeding (12) and hepatorenal syndrome (2). There were no peri-procedure deaths, however. Ninety-day mortality was 20%. Outcomes in model of end-stage liver disease score and biochemical characteristics post-TIPS were comparable to those reported. Overall, TIPS dysfunction rate was 35% at 1 year. TIPS follow-up and patency surveillance was an ad hoc combination of Doppler ultrasound and venography. Conclusion:, TIPS procedure outcomes in our centre are similar to those reported in the literature from large centres. TIPS patency rates may be improved with regular monitoring and early intervention when stenosis occurs. [source] CR10 LAPAROSCOPIC RIGHT HEMICOLECTOMY PERFORMED DURING THE ,LEARNING CURVE PHASE' DOES NOT IMPACT ON ONCOLOGICAL RESECTIONANZ JOURNAL OF SURGERY, Issue 2007E. Mignanelli Purpose Laparoscopic colectomy for the management of colonic neoplasia is technically feasible and increasingly popular. It is expected that the laparoscopic operation deliver similar oncological clearance to open operation. The ,learning curve' for laparoscopic right hemicolectomy has been estimated to be 20 cases and is now set as a guideline by ASCRS. This study was performed to compare histopathology specimens following laparoscopic right hemicolectomy (LRH) performed during the ,learning curve' phase with those following open right hemicolectomy (ORH) to evaluate oncological clearance of colonic neoplasms. Methods 125 patients were identified as having undergone right hemicolectomy by two surgeons for colonic neoplasia from January 2001. Data regarding patient details and tumour pathology were obtained by retrospective case note review. Thirty-five patients underwent LRH compared to 90 who had ORH during the same period. Histopathology from the two groups were compared for length of specimen resected, proximal and distal resection margins, size of tumour resected or number of lymph nodes harvested. Analysis was performed using Student's T-test. Results The two groups were matched with respect to age, sex and tumour characteristics. There was no significant difference between the groups in terms of length of specimen resected (p = 0.37), proximal (p = 0.29) and distal (p = 0.40) resection margins, size of tumour resected (p = 0.37) or number of lymph nodes harvested (p = 0.58). Conclusions ,Learning curve' laparoscopic right hemicolectomy allows similar lymphovascular clearance to traditional open surgery. [source] Routine investigations might be useful in pre-eclampsia, but not in gestational hypertensionAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2005David J. BAILEY Abstract Background:, Women referred to secondary care with suspected pregnancy-induced hypertension (PIH) are commonly investigated with blood tests and cardiotocography (CTG), regardless of the clinical severity of their condition. Over-investigation might lead to inappropriate intervention. Aims:, To investigate how often abnormal blood test and CTG results occur in women with pre-eclampsia and gestational hypertension and in women who do not have pregnancy-induced hypertension. Methods:, Retrospective case note review of 526 consecutive women referred with suspected pregnancy-induced hypertension to a district hospital. The frequency of abnormal test results and the pregnancy outcomes were analysed according to clinical classification. Results:, 36% of women referred did not meet the clinical criteria for a diagnosis of pregnancy-induced hypertension. Abnormalities of platelet count and/or liver function were seen in 11% of women with pre-eclampsia and in less than 2% of women with gestational hypertension and in a similar proportion of women who did not have pregnancy-induced hypertension. Gestational hypertension was associated with increased induction and caesarean birth rates, but not with low birthweight or preterm delivery. Progression from gestational hypertension to pre-eclampsia was not predicted by blood test abnormalities. Support for the routine use of antenatal CTG was not found. Conclusions:, A clinical diagnosis of pregnancy-induced hypertension should be confirmed before blood tests are ordered. The incidence of test abnormalities was only increased in pre-eclampsia and in gestational hypertension before term. CTG might only be of use in selected cases. [source] Maternal and neonatal outcomes in 54 triplet pregnancies managed in an Australian tertiary centreAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2004Andrea BARKEHALL-THOMAS Abstract Background:, To provide current data on maternal and neonatal outcomes in triplet pregnancies in an Australian population. Methods:, Retrospective case note review of all triplet pregnancies managed within a single Australian tertiary centre. Results:, Fifty-four sets of triplets were managed from January 1996 to October 2002. A total of 59% resulted from the use of assisted reproductive technologies. The median gestation at delivery was 32.5 weeks (range: 21,36 weeks); 14% delivered prior to 28 weeks and 43% delivered before 32 weeks. Preterm labour and preterm rupture of membranes were the most common antenatal complications occurring in 57 and 22% of pregnancies, respectively. A total of 93% of pregnancies were delivered by Caesarean section and 37% of mothers experienced at least one post-partum complication. A total of 96% of neonates were liveborn, with a median birthweight of 1644 g (range: 165,2888 g). The two most common neonatal complications were jaundice and hypoglycaemia in 52 and 43% of liveborn neonates, respectively. A total of 28% of neonates were below the 10th centile for gestational age and sex. A total of 8% of neonates demonstrated congenital anomalies. The perinatal mortality at a gestational age of 20,24 weeks was 100%, 22% at 25,28 weeks and zero for those babies born at 29 weeks or beyond. Conclusion:, Assisted reproductive technologies contribute significantly to the incidence of triplet pregnancies. Gestational age at delivery and perinatal mortality is comparable to published international data. Triplets born in a tertiary centre beyond 28 weeks gestation have a very favourable prognosis in the newborn period. [source] A longitudinal study over 5 to 10 years of clinical outcomes in women with idiopathic detrusor overactivityBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2008AR Morris Objective, To evaluate the long-term clinical outcome in women with idiopathic detrusor overactivity (IDO) and to identify significant prognostic factors. Design, Longitudinal study incorporating retrospective case note review and a postal questionnaire. Setting, Tertiary referral urogynaecology clinic in Australia. Population, Women with a sole urodynamic diagnosis of IDO. Methods, Audit of urodynamic records and case notes. Postal questionnaire incorporating validated disease-specific quality-of-life (QoL) instruments. Main outcome measure, Subjective assessment of overall improvement on a 4-point scale followed by scoring of short forms of the urogenital distress inventory and incontinence impact questionnaire. Results, One hundred and thirty two women were identified following examination of 1975 consecutive records with 76 (67%) returning questionnaires. Median follow up was 8 years (6,9), and the duration of symptoms was 13 years (9,18). Improvement was achieved in 25 (35%) women. Disease symptoms fluctuated in severity and QoL were worse in nonresponders to therapy (P < 0.0001). Urge incontinence at presentation was associated with treatment failure (P= 0.001) as was nocturia (P= 0.04), but urodynamic variables were not associated with outcome. Only 3 of 46 (6.5%) women not responding to therapy thought that their symptoms would improve with time. Conclusions, IDO seldom resolves and fluctuates in severity. Individual response is unpredictable, although the presence of urge incontinence is associated with a significantly worse prognosis. [source] Pregnancy outcome in severe placental abruptionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2003Salma Imran Kayani Objective To determine the relationship between decision to delivery interval and perinatal outcome in severe placental abruption. Design A case,control study. Setting Large inner city teaching hospital. Methods Retrospective case note review of pregnancies terminated following severe placental aburption and fetal bradycardia. One year paediatric follow up by case note review or postal questionnaire. The differences in outcome (death or cerebral palsy) were examined using non-parametric and univariate analysis for the following time periods , times from onset of symptoms to delivery, onset of symptoms to admission, admission to delivery, onset bradycardia to delivery and decision to delivery interval. Main outcome measures Prenatal death or survival with cerebral palsy. Results Thirty-three women with singleton pregnancies over 28 weeks of gestation, admitted with clinically overt placental abruption, where delivery was effected for fetal bradycardia. Eleven of the pregnancies had a poor outcome (cases), eight infants died and three surviving infants have cerebral palsy. Twenty-two pregnancies had a good outcome (controls): survival with no developmental delay. No statistically significant relationship was found between maternal age, parity, gestation, or birthweight and a poor outcome. A statistically significant relationship between time from decision to delivery was identified (P= 0.02, Mann,Whitney U test). The results of a univariate logistic regression for this variable suggest that the odds ratio of a poor outcome for delivery at 20 minutes compared with 30 minutes is 0.44 (95% CI 0.22,0.86). Fifty-five percent of infants were delivered within 20 minutes of the decision to deliver. Serious maternal morbidity was rare. Conclusion In this small study of severe placental abruption complicated by fetal bradycardia, a decision to delivery interval of 20 minutes or less was associated with substantially reduced neonatal morbidity and mortality. [source] Scleral wrap increases the long-term complication risk of bone-derived hydroxyapatite orbital implantsCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 8 2008Tze'Yo Toh MBBS(Hons) Abstract Background:, This study was prompted by previous findings that suggested that scleral wrapping increased the rate of complications following insertion of bone-derived hydroxyapatite orbital implants and compared the long-term results of implants inserted with and without scleral wraps. Methods:, This retrospective case series reviewed the long-term outcomes of 159 patients who had undergone enucleation with insertion of a bone-derived hydroxyapatite orbital implant at Dunedin Hospital between 1977 and 2006. Implants were inserted with and without scleral wraps in 85 and 74 cases, respectively. Follow up was 0.5,27.5 years (mean 8.2 years) for the whole series and 9.7 years for the sclera group and 6.7 years for the group without sclera. Patient details were obtained from theatre records, case note review, patient interview and examination, interview of patient relatives and family general practitioner records. The main outcome measures were the rates of minor or major complications and their treatments and outcomes. Results:, Twenty-seven cases (17%) suffered minor complications of limited implant exposure that either healed spontaneously, with implant drilling or wound resuturing and 11 cases (7%) suffered major complications requiring explantation. Of 38 patients with postoperative complications, 31 (82%) had scleral wraps compared with 7 (18%) without sclera (P < 0.001; OR 5.14, 95% CI 2.00,14.78). Conclusion:, Bone-derived hydroxyapatite orbital implants inserted without scleral wrap were associated with better clinical outcomes and a lower rate of long-term complications. It is therefore recommended that these implants be inserted without a scleral wrap. [source] Densiron intraocular tamponade: a case seriesCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2008Beng Liam Lim MBBS(Hons) MPH Abstract Purpose:, To report on the use of Densiron (heavy silicone oil), a new endotamponade agent with proposed benefits in complex retinal detachments involving inferior proliferative vitreoretinopathy. Method:, Retrospective case note review. Results:, Ten cases (10 eyes) in which Densiron was used in eyes which had failed initial retinal detachment surgery. The overall success rate of long-term total reattachment was 70%. Mean preoperative visual acuity was logMAR 2.03 (SD 0.406), which improved to a mean postoperative visual acuity of logMAR 1.00 (SD 0.571) (P = 0.001). Conclusion:, Densiron was well tolerated with few side-effects and appears to be a useful agent in patients with inferior proliferative vitreoretinopathy. [source] Response to Pothier et al. and Lowe on ,The NPTA may have underestimated tonsillectomy complications: a case note review of data submitted by two hospitals'CLINICAL OTOLARYNGOLOGY, Issue 2 2009R.E. McLaren No abstract is available for this article. [source] Long term follow-up of transcatheter coil embolotherapy for major colonic haemorrhageCOLORECTAL DISEASE, Issue 10 2010T. M. Ahmed Abstract Aim, Therapeutic angiography with embolization is fast becoming the preferred treatment modality for major bleeding in the lower gastrointestinal (LGI) tract. The aim of this study was to determine the long term outcome and complications of percutaneous coil embolization (PCE) and its efficacy as definitive therapy in patients with major LGI bleeding. Methods, All patients presenting to our institution with a haemodynamically significant LGI tract bleed between 1995 and 2001 that were unresponsive to conservative measures were considered for emergency angiography and coil embolization where appropriate. The outcome of these individuals was determined by case note review and telephone interview. Results, There were 20 patients (11 females) with a mean follow-up period 72 months, mean age was 67 years. All underwent PCE following positive angiogram. The most common site of bleeding was the right colon (40%); haemostasis was successfully achieved in 16 (80%) patients. Five of the 20 patients died within 30 days of the intervention, three following PCE and two following surgery. None of the mortality following PCE was considered procedure related. On long term follow-up four patients required readmission to hospital for further LGI bleeds at 1, 2, 12 and 16 months respectively. Ischaemic complications occurred in 23%. Conclusion, Superselective embolization as the primary technique for the treatment of haemodynamically significant LGI bleeding is an effective, feasible and safe technique. Long term follow-up in our series up to 72 months has shown that it should be considered as both a primary and potentially definitive treatment for life threatening LGI bleeds. [source] The impact of spontaneous tumour perforation on outcome following colon cancer surgeryCOLORECTAL DISEASE, Issue 8 2008A. S. Abdelrazeq Abstract Objective, The impact of spontaneous tumour perforation on survival following surgery for colon cancer is unclear. This study compares survival outcomes for patients with perforated colonic cancer with stage-matched nonperforated cancer. Method, A prospective histological database was searched for all patients undergoing resection for adenocarcinoma of the colon between 1996 and 2002. Patients with T4 cancer were selected and classified into those with spontaneous perforation at the tumour site and those with nonperforated tumour. Patients with synchronous colonic and rectal cancers, familial polyposis, inflammatory bowel disease, iatrogenic or remote colonic perforation were excluded. Histological variables were combined with clinical data obtained by case note review. Data were analysed for differences in demographics, histological variables, operative mortality, disease-free and overall survival. Multivariate analysis of factors predictive of overall survival in both groups was performed. Results, Of 960 patients identified, 52 patients had spontaneous tumour perforation and 82 patients served as the T-stage matched control group. Overall survival at 2 years was 47% and 54% and at 5 years was 28% and 33% for perforated and nonperforated cancers respectively. Patients with perforated cancers were more likely to present with metastatic disease and undergo emergency surgery with a higher 30-day mortality. There was a trend towards reduced overall survival in the perforated group (P = 0.06), but no difference in disease-free survival (P = 0.43). On multivariate testing, ,emergency surgery' and ,age >75 years' were the only independent predictors of mortality in the perforated and nonperforated group respectively. Conclusion, Both perforated and nonperforated T4 colon cancers have a poor prognosis. Spontaneous perforation of the cancer is associated with reduced overall survival, due to higher 30-day mortality, but in itself does not appear to significantly impact on disease-free survival. Rather, it is the advanced oncological stage at which perforated cancers present that determines outcome. [source] Transanal endoscopic microsurgery , lessons from a single UK centre seriesCOLORECTAL DISEASE, Issue 6 2002G. M. Lloyd Abstract Objectives Transanal endoscopic microsurgery (TEM), a minimally invasive technique has been employed in the excision of benign and selected malignant rectal tumours since 1983. We present a single surgeon's series of 102 procedures. Patients and methods A retrospective case note review of 102 procedures performed over a 6-year period between 1996 and 2001. Results One hundred and two TEM procedures were performed on 100 patients. 68 for adenomas, 19 potentially curative excisions for carcinoma, 13 palliative procedures for advanced carcinoma and 2 for solitary rectal ulcer syndrome (SRUS). Four adenomas recurred and were successfully treated by various procedures. None went on to develop malignancy, or a further recurrence. Of the cancers, six T1 and 10 T2 were excised with curative intent. Three T3 cancers were excised before endorectal ultrasound was available in the unit and went on to have definitive procedures. One T1 and two T2 carcinomas were not completely histologically excised. These patients were offered definitive procedure and there have been no recurrences. 11 patients underwent palliative TEM procedures, 2 went on to have a recurrence of symptoms. Both underwent a successful second TEM procedure. Conclusions Although longer term follow up is still required, TEM appears to be an effective method of excising benign tumours and T1 carcinomas of the rectum. The role of TEM in the treatment of T2 carcinomas is, as yet, unclear and needs further evaluation although the results of our series and others are encouraging. [source] Foot abnormalities in Canadian Aboriginal adolescents with Type 2 diabetesDIABETIC MEDICINE, Issue 7 2007J. Chuback Abstract Aims To determine the profile of foot abnormalities in Canadian Aboriginal adolescents with Type 2 diabetes and the risk factors associated with these abnormalities. Methods Aboriginal adolescents with Type 2 diabetes underwent an interview, medical record review and foot examination in a tertiary care, paediatric hospital diabetes clinic and two geographically remote outreach clinics. The notes of 110 subjects were reviewed [mean age 15 ± 3 years; mean duration of diabetes, 30 ± 20 months; 71 (66%) female and 39 (34%) male] and 77 (70%) of the subjects were examined. Results Foot abnormalities were identified by either interview or notes review, and included poor toenail condition in 85 (77%), paronychia in 29 (26%), ingrowing toenails in 16 (15%) and neuropathic symptoms in 13 (12%) subjects. Foot abnormalities were identified by examination in many subjects, including poor toenail condition in 38 (49%), calluses in 34 (44%) and paronychia in 13 (17%) subjects. Eighteen (24%) of 75 subjects did not have running water in the home. Factors that significantly increased the presence of foot abnormalities included: foot care provided by a person other than self; absence of running water in the home; decreased frequency of bathing; and decreased frequency of nail clipping. A greater percentage of subjects living on a reservation or rural community had specialized consultations for retinal examination, footwear, or both than of those living in an urban or unknown residence. Conclusions A high prevalence of foot abnormalities was noted in Aboriginal adolescents with Type 2 diabetes. These findings highlight the associated comorbidities in this population, emphasizing the need for early detection and intervention. [source] | |||||||||||||||||||||||||