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Pyloric stenosis: unusual presentations and rare assoclations.

Pyloric stenosis is a common paediatric surgical condition with a well-recognised pattern of clinical features. Diagnosis is usually straightforward and a Ramstedt pyloromyotomy is curative. We present three patients who developed pyloric stenosis incidentally during the management of other primary surgical conditions. Issues of diagnostic difficulty following presentation of pyloric stenosis in the post-operative period (all three patients), its rare syndromic associations (one patient) and its management in this unusual situation are discussed. An awareness of the unusual presentations of py

The three in one procedure: how I do it.

Recurrent patella dislocation is common, and selection of an appropriate stabilisation procedure is important for a successful outcome. We describe a combined proximal and distal realignment procedure to adjust soft tissue tension around the patella. This procedure, the 'Three in One' involves a combination of a lateral release, vastus medialis obliquus muscle advancement, and transfer of the medial third of the patellar tendon to the medial collateral ligament. This is a safe, reliable procedure for patients with recurrent dislocation of the patella resulting from an imbalance of soft tissue

Intraspinal lumbar synovial cysts: diagnosis and surgical management.

BACKGROUND: Lumbar synovial cysts are a common association of facet joint degenerative disease. However, it is relatively rare for these cysts to cause symptoms of radiculopathy and nerve root compression. PATIENTS AND METHODS: We report a series of eight cases which were treated over a period of 20 months. There were five female and three male patients with a mean age of 66 years, and an average follow-up of seventeen months. All patients had pre-operative flexion/extension radiographs and MRI scans. Two patients had failed non-surgical treatment, two were associated with a Grade 1 spondylol

Surveillance for Barrett's oesophagus: is there light the end of the metaplastic tunnel?

Metaplastic change of the oesophageal epithelium from normal stratified squamous to columnar-lined with intestinal metaplasia results in an increased risk of development of adenocarcinoma. As a result, endoscopic surveillance has been recommended for the surgically-fit patient. The evidence that these programmes are altering clinical outcome to any major degree, however, is weak. This review highlights some of the areas of controversy and outstanding points that need to be clarified to allow establishment of evidence-based medicine for this condition.

Inflammatory bowel disease: dysfunction of GALT and gut bacterial flora (II).

The precise cause(s) of Crohn's disease and ulcerative colitis are unknown. From animal models and human studies it is well established that gut bacterial flora are essential for inducing the bowel inflammation. Animal models, when kept in a germ-free environment, do not develop colitis until the gut flora is reconstituted. It is not clear whether the bacterial antigens (Ags) from the normal flora or some other pathogenic bacterial Ags induce/propagate the inflammatory process in inflammatory bowel disease (IBD). Despite extensive research it has not been possible to identify any specific bact

Mirizzi syndrome: a diagnostic and operative challenge.

INTRODUCTION: Mirizzi syndrome (MS) is an unusual complication of gallstone disease. The majority of cases are not identified pre-operatively, despite advances in imaging techniques. MATERIALS AND METHODS: Eighteen cases of MS were treated between January 1997 and April 2002. The clinical presentation, modes of investigation, surgical management and outcome are retrospectively reviewed. RESULTS: There were 13 female and 5 male patients, with a mean age of 60 years. Seven patients presented with the classical Charcot's triad. Ultrasonography (US) was the first imaging investigation in 13 pati

A selective approach to histopathology of the gallbladder is justifiable.

BACKGROUND: Recent changes in the NHS have led to a considerably increased workload for histopathologists prompting the publication of guidelines from the Royal College of Pathologists regarding specimen analysis. In most hospitals, cholecystectomy specimens are routinely sent for histology regardless of whether or not there is any visible macroscopic abnormality suggestive of malignancy. Our aim was to assess whether it would be safe to adopt a policy of processing only suspicious gallbladders without compromising patient management and outcome. METHODS: A retrospective analysis of all chole

Early twentieth century surgical urology: the 1909-1939 experience of Henry Wade.

This historical review uses the experience of Henry Wade (1876-1955) to examine the state of surgical urology in the early decades of the twentieth century. For 50 years, Wade was a central figure in the life of the Royal College of Surgeons of Edinburgh. His work epitomises Scottish surgery in the years between 1909 and 1939. Wade adopted every available technique to arrive at the precise diagnosis of urinary tract disease. An exact clinical history and examination were followed by the testing of the urine, the analysis of the blood, radiography and cystoscopy. During his time, urological sur

Reduction of nasal fractures under local anaesthesia: an acceptable practice?

Nasal fractures are among the most common bony injuries and are among the most frequent reasons for referral to Otorhinolaryngology departments resulting in significant pressure on clinical resources. We present our experience of a Nasal Fracture Clinic dedicated to the assessment of nasal injuries. A prospective study has been undertaken using questionnaires regarding patient satisfaction and acceptability of manipulation under a local anaesthetic (LA). During our three-month study period 91 new patients with nasal injuries were seen; 43 patients were diagnosed to have a displaced nasal fract

Biocompatibility: a biomechanical and biological concept in total hip replacement.

The insertion of any implant or prosthesis into bone usually changes the biomechanical environment and, thus, alters the stresses and strains applied to the bone. Both bone overload and excessive stress protection can result in bone resorption. The material and geometry of any implant should be designed to avoid excessive flexural mismatch. Incompatibility of materials may result in interface and mechanical failure, with the consequent generation of particulate debris, subsequent osteolysis and implant failure. Particulate debris can be generated from articulating surfaces and from any other m

Changes in health in Belgium, 1990-2016: a benchmarking analysis based on the global burden of disease 2016 study.

BACKGROUND: Despite increasing of the Belgian health expenditures, several indicators related to population health showed poor results. The objectives of this study were to perform an in-depth analysis of the secular trend of Belgian health status using the Global Burden of Disease (GBD) 2016 study results for Belgium, and to compare these results with other European countries. METHODS: We collected results of the Global Burden of Disease 2016 study through the GBD results and visualization tools. We benchmarked Belgian GBD results with the other initial members of the European Union (EU15).

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… Benchmarking We benchmarked Belgian GBD results with the other initial members of the European Union (EU15) – i.e., Austria, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden and the United Kingdom. … 1990 and 2016, EU15 Country | Difference DALYs 90–16 per 100.000 | LB 95%UI | UB 95% UI | % YLLs in Difference DALYs 90–16 | % YLDs in Difference DALYs 90–16 Portugal | − 9131 | −9221 | − 9232 | 96% | 4% Luxembourg | − 8813 | − 8749 | − 8956 | 94% | 6% Finland | − 8345 | − 8212 | − 8494 | 95% | 5% Ireland …

Characteristics and outcomes of Bahraini pediatric patients sent abroad for bone marrow transplantation: A ten-year retrospective cohort study.

BackgroundBone marrow transplantation (BMT) is a breakthrough procedure for patients with hematological and oncological conditions, particularly when all other treatments fail. Its indications vary between patients and settings, and its outcomes depend on the donor type, transplantation facility, and center expertise. In countries where transplantation facilities are lacking, sending patients abroad for transplantation might be a safe and effective alternative to leaving the patient to face eventual disease morbidity or even mortality if the procedure is not performed locally. However, studies

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… Shahd T Bucheeri, School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen 15503, Bahrain. Jarrah Y Aldoseri, School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen 15503, Bahrain. … Ayah A Redha, School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen 15503, Bahrain. Abdulla F Mubarak, School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen 15503, Bahrain. …

Incidence trends for twelve cancers in younger adults-a rapid review.

Many cancer referral guidelines use patient's age as a key criterium to decide who should be referred urgently. A recent rise in the incidence of colorectal cancer in younger adults has been described in high-income countries worldwide. Information on other cancers is more limited. The aim of this rapid review was to determine whether other cancers are also increasing in younger age groups, as this may have important implications for prioritising patients for investigation and referral. We searched MEDLINE, Embase and Web of Science for studies describing age-related incidence trends for color

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… For example, one study [ 47 ] reported that the proportion of patients under 50 presenting with Stage 4 colorectal cancer in the Republic of Ireland has doubled in recent years, from 11% in 1994 to 23% in 2012. … Ullah MF Fleming CA Mealy K Changing trends in age and stage of colorectal cancer presentation in Ireland—from the nineties to noughties and beyond Surgeon 2018 16 350 4 10.1016/j.surge.2018.03.006 29680182 48. …

Is severe hypocalcemia immediately life threatening?

ObjectiveSevere hypocalcemia (Ca MethodsA retrospective observational study was carried out over a 2-year period in the Adult Emergency Department (ED) of Nantes University Hospital. All patients who had a protein-corrected calcium concentration measure were eligible for inclusion. Patients with multiple myeloma were excluded. The primary outcome was the number of life-threatening cardiac arrhythmias and/or neurological complications during the stay in the ED.ResultsA total of 41,823 patients had protein-corrected calcium (pcCa) concentrations measured, 155 had severe hypocalcemia, 22 were exc

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… Incidence of hypocalcemic seizures due to vitamin D deficiency in children in the United Kingdom and Ireland. Journal of Clinical Endocrinology and Metabolism 2015. 100 91–95. ( 10.1210/jc.2014-2773) 19. Parfitt AM. Correction of plasma calcium measurements. … Basser L, Neale FC, Ireland AW, Posen S. Epilepsy and electroencephalographic abnormalities in chronic surgical hypoparathyroidism. Annals of Internal Medicine 1969. 71 507–515. ( 10.7326/0003-4819-71-3-507) 25. Bhadada SK, Bhansali A, Upreti V, Subbiah S, Khandelwal N. …

Quality indicators and patient outcome measures for palliative care in cancer patients: a systematic review.

IntroductionWith the exponential rise in global cancer incidence, the surge in demand for palliative care has outstripped capacity, limiting patients' access to quality and holistic palliative care, especially in low- and middle-income countries. Despite an upturn in research activity, evidence in palliative care remains limited, given its complexity as well as the shortage of standardised quality indicators (QIs) and patient outcome measures (POMs). The objective of this systematic review is to assess the QIs and POMs used to evaluate palliative care service on aggregated and individual level

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… . | General | Process | Emergency room visits, hospitalisation, ICU admission and chemotherapy administration in the last 30 days of life and hospital death Northern Ireland | McFerran et al [ 29 ] | Cost consequences of unscheduled emergency admissions in cancer patients in the last year of life | Public … Health Agency of Northern Ireland, Cancer Focus Northern Ireland and Health Data Research UK, Macmillan-NI Cancer Registry Partnership (2016) | Quantitative | Descriptive, observational | 3,134 | Cancer | To examine the utilisation of unscheduled emergency end-of-life healthcare and estimates expenditure …

The complex price setting and reimbursement of non-industrial advanced therapy medicinal products.

BACKGROUND: Advanced Therapy Medicinal Products (ATMPs) developed under the Hospital Exemption (HE) offer innovative treatments for patients with unmet medical needs, but their pricing and reimbursement (P&R) remain fragmented and poorly understood. This paper examines the P&R landscape for HE-ATMPs developed by academic developers in Spain, based on the Spanish costing guideline and extends the analysis to HE-ATMPs developed by academic and non-profit developers across Europe. METHODS: We conducted a mixed-method, exploratory study combining literature review with interviews and email enquiri

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… HE-ATMPs are reimbursed by the National Health Service (NHS) in 10 countries (Austria, Denmark, Estonia, Finland, Germany, Ireland, Portugal, Spain, Sweden and the Netherlands). In Denmark and Sweden, the reimbursement is applied at regional level. … Regarding costing model used for P&R decisions, the cost-based approach (i.e., no profit expected) is the most frequent among EU Member States (Denmark, Estonia, Finland, Ireland, Italy, Lithuania, Portugal and Sweden. …

National burden of cancer in Italy, 1990-2017: a systematic analysis for the global burden of disease study 2017.

We monitored the burden of cancer in Italy and its trends over the last three decades, providing estimates of cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs), for cancer overall and 30 cancer sites using data from the Global Burden of Disease study 2017. An overview of mortality trends between 1990 and 2017 was also provided. In 2017, there were 254,336 new cancer cases in men and 214,994 in women, corresponding to an age-standardized incidence rate (ASIR) of 438 and 330/100,000, respectively. Between 1990 and 2017, incid

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… , ICD-10 C46), benign/in situ neoplasms (ICD-10 D00-D49), and other malignant neoplasms (ICD-10 codes C17, C30-C31, C37, C38, C40-C41, C47-C49, C4A, C51-C52, C57-C58, C60, C63, C66, C68, C69, C74-C75). b Includes Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland … , ICD-10 C46), benign/in situ neoplasms (ICD-10 D00-D49), and other malignant neoplasms (ICD-10 codes C17, C30-C31, C37, C38, C40-C41, C47-C49, C4A, C51-C52, C57-C58, C60, C63, C66, C68, C69, C74-C75). b Includes Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland …

Building a comprehensive cancer survivorship program.

There is a significant increase in the number of people surviving cancer as a result of improved detection and better treatments. In the United States (US) alone, these numbers are estimated to reach 20 million by 2026 [Miller et al (2016) CA Cancer J Clin 66(4) 271-289)]; [Bluethmann et al (2016) Cancer Epidemiol Biomarkers Prev 25(7) 1029-1036]. Living through cancer treatment represents a life-changing event, often including residual and long-term emotional, physical, psychological and spiritual sequelae. Survivorship programming must encompass the clinical management of medical issues, loc

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… Refining survivorship care As standards for survivorship care are refined and expanded throughout the US, there are many lessons that can be learned from the innovative approaches developed in England and Ireland [ 3 , 4 ]. … Building personalized cancer follow-up care pathways in the United States: lessons learned from implementation in England, Northern Ireland, and Australia. Am Soc Clin Oncol Educ Book. 2019;39:625–639. doi: 10.1200/EDBK_238267. 4. Alfano CM, Mayer DK, Bhatia S, et al. …