Showing papers in "Annals of The Royal College of Surgeons of England in 2006"

The Value of Modified Early Warning Score (MEWS) in Surgical In-Patients: A Prospective Observational Study

Abstract: INTRODUCTION The Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients. PATIENTS AND METHODS A total of 334 consecutive ward patients were prospectively studied. MEWS were recorded on all patients and the primary end-point was transfer to ITU or HDU. RESULTS Fifty-seven (17%) ward patients triggered the call-out algorithm by scoring four or more on MEWS. Emergency patients were more likely to trigger the system than elective patients. Sixteen (5% of the total) patients were admitted to the ITU or HDU. MEWS with a threshold of four or more was 75% sensitive and 83% specific for patients who required transfer to ITU or HDU. CONCLUSIONS The MEWS in association with a call-out algorithm is a useful and appropriate risk-management tool that should be implemented for all surgical in-patients.

Dead Men and Radiologists Don't Lie: A Review of Cadaveric and Radiological Studies of Rotator Cuff Tear Prevalence

Abstract: INTRODUCTION Rotator cuff tears are a common pathology, with a varied prevalence reported. PATIENTS AND METHODS A literature review was undertaken to determine the cadaveric and radiological (ultrasonography and magnetic resonance imaging [MRI]) prevalence of rotator cuff tear. The radiological studies were subdivided into symptomatic and asymptomatic subjects. RESULTS Cadaveric rotator cuff tears were found in 4629 shoulders of which only 2553 met the inclusion criteria. The prevalence of full-thickness tears was 11.75% and partial thickness 18.49% (total tears 30.24%). The total tear rate in ultrasound asymptomatic was 38.9% and ultrasound symptomatic 41.4%. The total rate in MRI asymptomatic was 26.2% whilst MRI symptomatic was 49.4%. DISCUSSION The unselected cadaveric population should contain both symptomatic and asymptomatic subjects. A prevalence of tears between the symptomatic and asymptomatic radiological groups would be expected. However, apart from the MRI asymptomatic group, the radiological prevalence of rotator cuff tears exceeds the cadaveric. CONCLUSIONS Rotator cuff tears are frequently asymptomatic. Tears demonstrated during radiological investigation of the shoulder may be asymptomatic. It is important to correlate radiological and clinical findings in the shoulder.

The Surgical Risk of Suprapubic Catheter Insertion and Long-Term Sequelae

Abstract: INTRODUCTION Suprapubic catheter (SPC) insertion is a common urological procedure, which is often referred to as safe and simple even in inexperienced hands There is, however, very little published evidence on the safety of this procedure Our study aimed to provide evidence on the associated morbidity and mortality and provide guidance for practising clinicians PATIENTS AND METHODS A total of 219 patients who underwent SPC insertion under cystoscopic guidance at two urology institutions between 1994 and 2002 were identified and their case notes reviewed RESULTS The intra-operative complication rate was 10% and the 30-day complications rate was 19% Mortality rate was 18% Long-term complications included recurrent UTIs (21%), catheter blockage (25%) resulting in multiple accident and emergency attendance (43%) Despite this, the satisfaction rate was high (72%) and most patients (89%) prefer the SPC over the urethral catheter CONCLUSIONS SPC bladder drainage results in a high patient satisfaction rate Patients and clinicians should be aware of the potential complications associated with SPC insertion

Skills for Communicating with Patients (2nd edn)

Abstract: Will any of us admit that our communication skills are below par? Could we take a better history? Could we help patients to better understand and participate in their treatment? Will this book, now in its second edition, help practising surgeons to improve their communication skills and hopefully help to avoid complaints and litigation, so many of which stem from misunderstanding? In the first chapter, ‘Defining what to teach and learn: an overview of the communication skills curriculum’, the style is such that I was not sure if this book was going to be a manual for teachers and organisers of courses or an instruction book for students. Helpfully, in the introduction the authors ask: ‘Who is the intended audience?’ The reply they give includes learners at all levels of education, facilitators and programme directors, medical educators, medical education administrators, funding agencies and medical politicians. In fact, just about everybody and, having read the remaining seven chapters, I agree with them and suggest that there are very few of us who could not benefit from a diligent reading of this book. A stylistic irritation stems from its joint Canadian and English authorship. The authors try to fend off any criticism in this area with another useful question in the introduction: ‘How have we addressed style issues in a book intended for the European, North American and wider international market?’ Indeed, there is a little glossary to explain, for example, that they use the term ‘specialist’ rather than ‘consultant’ and ‘resident’ rather than ‘registrar’. Nevertheless, in a book concerned with clarity of communication, this is somewhat irksome. Chapter 1 is about defining what to teach and learn and describes the important Calgary–Cambridge Guide, for which these authors are well known. The next six chapters provide a detailed exposition of the skills of this framework: ‘Initiating the session’, ‘Gathering information’, ‘Providing structure to the interview’, ‘Building a relationship’, ‘Explaining and planning’ and, finally, ‘Closing the session’. There is a final chapter dealing with specific issues, such as breaking bad news and age-related issues. The layout of the chapters is good and clear, and there are useful shaded boxes to summarise some aspects together with boxes which include snippets of patient–doctor dialogue to emphasise particular points. The authors make much of the fact that this volume is research-based and provide references for many of the points that they make. Chapter 6, ‘Explanation and planning’, is particularly well referenced. In some places, however, they have the slightly irritating habit of saying ‘we know from research…’ and then fail to provide a reference to the relevant work. There is a further reading section and a reference section which includes around 450 entries. The main effect this book had on me is that now, when I speak to patients, I find myself checking that I have given them enough time to respond and check that they have understood what I have said. In short, I believe that use of the advice in this book cannot help but make you a better doctor.

Size matters for sarcomas

Abstract: INTRODUCTIONBy the time of diagnosis, sarcomas have frequently reached a large size and many patients have a long history of symptoms prior to diagnosis. The aim of this study was to assess whether...

Management of Dupuytren's disease--clear advice for an elusive condition.

Abstract: Dupuytren's disease is a progressive fibroproliferative disorder of an unknown origin affecting the hands causing permanent flexion contracture of the digits. Significant risk factors for development of Dupuytren's disease include old age, male sex, white northern European extraction, presence of positive family history of Dupuytren's disease, and diabetes mellitus. The disease also seems to deteriorate rapidly in those cases showing young age of onset and additional fibromatosis affecting the back of the hands, soles of the feet and the penis. Although there is no cure, patients with Dupuytren's disease of the hand may gain a significant functional benefit following surgical improvement or correction of the deformity. With realistic expectations, timely and appropriate surgical technique in a specialist centre, and attention to postoperative recovery and rehabilitation (occupational therapy and physiotherapy support), a beneficial outcome can be achieved in most cases.

Use of icodextrin 4% solution in the prevention of adhesion formation following general surgery: from the multicentre ARIEL Registry.

Abstract: INTRODUCTIONIntra-abdominal adhesions occur in many patients following major abdominal surgery and represent a serious burden to patients and healthcare providers. The multicentre ARIEL (Adept® Registry for Clinical Evaluation) Registry was established to gather clinical experiences in the use of icodextrin 4% solution, an approved adhesion-reduction agent, during routine general surgery. PATIENTS AND METHODSGeneral surgeons from five European countries completed anonymised data collection forms for patients undergoing laparotomy or laparoscopy. Surgeons recorded patient demographics, use of icodextrin 4% solution and adverse events, and made subjective assessments of ease of use and patient acceptability with the agent. RESULTSThe general surgery registry included 1738 patients (1469 laparotomies, 269 laparoscopies). Leakage of fluid from the surgical site did not appear to be affected by icodextrin 4% solution and was classified as ‘normal’ or ‘less than normal’ in most patients (laparotomies 86%, lapar...

The management of incisional hernia.

Abstract: Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wounds is between 10-15%, creating a large problem of incisional hernia. In the past many of these hernias have been neglected and treated with abdominal trusses or inadequately managed with high failure rates. The introduction of mesh has not had a significant impact because surgeons are not aware of modern effective techniques which may be used to reconstruct defects of the abdominal wall. This review will cover recent advances in incisional hernia surgery which affect the general surgeon, and also briefly review advanced techniques employed by specialist surgeons in anterior abdominal wall surgery.

A Prospective, Randomised, Controlled Trial Comparing Wound Dressings Used in Hip and Knee Surgery: Aquacel and Tegaderm Versus Cutiplast

Abstract: INTRODUCTIONCutiplast (absorbent perforated dressing with adhesive border; Smith & Nephew) is commonly used following orthopaedic operation, but complications of its use have been reported. A prospective, randomised, controlled study was performed to compare the efficacy of Cutiplast versus an Aquacel (hydrofibre dressing; ConvaTec) covered with Tegaderm (vapour-permeable dressing; 3M). PATIENTS AND METHODSTwo-hundred patients were randomised to receive one of the two dressings following elective and non-elective surgery of the hip and the knee. We were able to study 183 patients. The condition of the wound and any complications such as skin blistering or signs of infection was noted as was the frequency of dressing changes. RESULTSThe Aquacel and Tegaderm dressing was 5.8 times more likely to result in a wound with no complications as compared to a Cutiplast dressing (odds ratio, 5.8; 95% CI 2.8–12.5; P < 0.00001). CONCLUSIONAquacel covered by Tegaderm is a superior dressing to Cutiplast following surger...

Patients with clinical acute appendicitis should have pre-operative full blood count and C-reactive protein assays.

Abstract: INTRODUCTIONThe role of inflammatory markers in the diagnosis of acute appendicitis has not been clearly defined. The aims of this prospective audit were to define the role of the serum markers of inflammation total white cell count, neutrophil count and C-reactive protein in the diagnosis of acute appendicitis with particular reference to the discrimination between uncomplicated and complicated appendicitis, and the prediction of abscess. PATIENTS AND METHODSThe author compiled a prospective database over a 13-month period of all appendicectomies performed. After five exclusions (three having no notes for review and two having confounding second morbidity in the presence of a normal appendix), the data relating to 75 patients were analysed. RESULTSIn patients judged on clinical grounds to require laparotomy for suspected acute appendicitis, white cell count and neutrophil count distinguish acute appendicitis from normal appendices when used as categorical variables, though they do not reflect the presenc...

Prevalence of HIV status and CD4 counts in a surgical cohort: their relationship to clinical outcome.

Abstract: Human immunodeficiency virus (HIV) infection continues to be a major cause of morbidity and mortality in South Africa. The epicentre of the epidemic in South Africa is the Province of KwaZulu-Natal (KZN) with an annual antenatal prevalence rates of 35% in 2002 compared with the national figure of 22.4%. 1 In a Durban (KZN's largest city) public hospital intensive care unit study, conducted in 1996, 13% of trauma patients were HIV positive. 2 A steady increase in ABSTRACT INTRODUCTION HIV positivity alone as a predictor of surgical outcome has not been extensively studied in regions of high prevalence. The aim was to determine the prevalence of HIV infection in surgical patients, and compare differences in their clinical course based on their serological status and CD4 counts. PATIENTS AND METHODS A prospective cohort of 350 patients, enrolled over 6 weeks, were studied. HIV status was determined in all patients. HIV-positive patients had CD4 counts. Clinical details were collated with HIV data after completion of enrolment. RESULTS Of the 350 patients, all but 6 were black South Africans. The median age was 31 years (range, 18-82 years). There were 143 trauma and 207 non-trauma patients. The male:female ratio was 1.4:1. The overall HIV seropositivity rate was 39% (females, 46%; males, 36%). Overall, 228 patients had surgical intervention and 96 patients had drainage of sepsis. The hos- pital stay (HIV negative, 11.9 ± 15.9 days; HIV positive, 11.0 ± 15 days) and mortality (HIV positive, 3.6%; HIV negative, 3.7%) did not differ by major diagnostic category. For HIV-positive patients, the male:female ratio was 1.2:1. There were 54 trauma and 83 non-trauma patients. An operation for the drainage of a septic focus was commoner in the HIV-positive admis- sions. Thirty-two (24%) patients had CD4 counts less than 200 cells/mm 3 , (i.e. AIDS). The hospital mortality, hospital stay and severity of sepsis were not related to CD4 counts. CONCLUSIONS HIV status does not influence the outcome of general surgical admissions and should not influence surgical management decisions. In HIV-positive surgical patients, CD4 counts have no relation to in-hospital outcome in a heteroge- neous group of surgical patients.

Teaching and Assessing Surgical Competence

Abstract: Surgical competence and its assessment is one of the most hotly debated topics engaging the profession. In the current climate of diminishing working hours and shorter training, the surgical profession is having to address the complex issue as to how surgery as a craft specialty should be taught, and how to assess when an individual is competent within their chosen sphere as well as how that competence should be maintained. Internationally, there is political pressure upon the professional to achieve contracted activity to comply with political imperatives and, at the same time, to achieve a greater degree of specialisation. Within Europe, the working time directive has led to a shift system of rotas and this, along with a shorter overall period of training, has led to reduced time available to surgical trainees in which to learn their craft.

The effect of total hip replacement on the employment status of patients under the age of 60 years.

Abstract: INTRODUCTIONA retrospective study was undertaken of a consecutive cohort of 86 patients (101 hips) under the age of 60 years operated on by a single orthopaedic team between 1993 and 2003 at a district general hospital. PATIENTS AND METHODSDemographic and diagnostic data were collected from patients’ hospital records, and a detailed questionnaire regarding occupational status was used at follow-up. RESULTSNearly all of the patients working prior to surgery returned to employment following surgery. Nearly half of those not working pre-operatively regained employment postoperatively; among those that did not return to work, this was for reasons unrelated to their hip. Those patients who had been out of work prior to their surgery took significantly longer to return to work. CONCLUSIONSOur study demonstrates that total hip replacement is effective in keeping patients under the age of 60 years employed. It is also effective in allowing those already off work due to hip pain to return to work, although there i...

Sacral Nerve Neuromodulation for the Treatment of Lower Bowel Motility Disorders

Abstract: INTRODUCTIONIncontinence and constipation are common and cause a high degree of physical, social and psychological impairment. Maximal conservative therapy may improve some patients but many remain symptomatic. Surgical options are often unsatisfactory, with variable result and further options are limited. Sacral nerve stimulation uses electrical stimulation applied to the sacral nerves, eliciting a physiological effect on the lower bowel, anal sphincter and pelvic floor, resulting in clinical benefit. The objective of this study was to investigate whether sacral nerve neuromodulation can improve patients with disorders of bowel motility, when current maximal treatment has failed and to investigate the underlying physiological mechanism of action. RESULTSIncontinence: Nineteen patients, age 58 years (range, 37–71 years), with resistant incontinence for 6 years (range, 2–21 years) underwent stimulation. Continence improved in all at 24 months (range, 3–60 months), fourteen fully continent. Incontinent epis...

Can a urinary tract symptom score predict the development of postoperative urinary retention in patients undergoing lower limb arthroplasty under spinal anaesthesia? A prospective study.

Abstract: INTRODUCTION There is no general consensus amongst orthopaedic surgeons on how best to manage the urinary tract and its complications after lower limb arthroplasty This prospective audit investigates whether postoperative urinary retention can be predicted pre-operatively using the validated International Prostate Symptom Severity score (IPSS) PATIENTS AND METHODS A total of 182 patients undergoing lower limb arthroplasty under spinal anaesthetic were given the IPSS questionnaire to complete pre-operatively and an audit into numbers catheterised postoperatively was performed RESULTS Overall, 69% of males and 39% of females required catheterisation Following logistic regression analysis there was 085 predicted probability that males over 70 years would require catheterisation The IPSS score was not useful in predicting retention in either sex at any age CONCLUSIONS We propose that all males over 70 years undergoing this type of surgery should be catheterised pre-operatively and all other patients should be catheterised postoperatively with close monitoring of bladder volumes to prevent established urinary retention

Haematospermia – A Systematic Review

Abstract: Haematospermia (or haemospermia) is a distressing symptom in sexually active men. In most cases, it is caused by non-specific inflammation of the prostate and seminal vesicles. In a small percentage of men, however, it may be a manifestation of genito-urinary or systemic malignancy, in particular prostate cancer. The purpose of this review is to explain the causes and management of patients with haematospermia.

Catamenial pneumothorax: surgical repair of the diaphragm and hormone treatment.

Abstract: Catamenial pneumothorax is defined as spontaneous pneumothoraces occurring within 72 h before or after onset of menstruation. It is rare but clinical index of suspicion should be high in ovulating women with spontaneous pneumothoraces. The mechanism is unclear but is thought to involve pre-existing or acquired diaphragmatic defects and endometrial implants. Traditional therapy involving hormonal treatment or surgical pleurodesis alone is associated with high rates of recurrence. A series of four patients with catamenial pneumothorax managed at our institution is presented to highlight the condition to various surgical specialties to whom it may present, and to emphasise the importance of both surgical and hormonal interventions in preventing recurrence. Each patient underwent video-assisted thoracoscopic inspection of the diaphragm, mechanical pleurodesis and, most importantly, repair of diaphragmatic defects with an artificial mesh. Surgical treatment was strictly followed by a course of gonadotrophin-releasing hormone analogue therapy in three patients, with no recurrence to date (longest follow-up 45 months). The fourth patient suffered a postoperative recurrence when hormonal treatment was delayed for 6 weeks, stressing the importance of hormonal treatment in conjunction with surgery.

Symptomatic presentation of early colorectal cancer

Abstract: INTRODUCTION It is believed that increased detection of earlier stage colorectal cancer can only be achieved by screening asymptomatic individuals. We describe a referral pathway for a symptomatic population which achieves a 30% Dukes’ A detection rate. PATIENTS AND METHODS From October 1999, 4253 patients with distal colonic symptoms, referred by general practitioners, completed a patient consultation questionnaire (PCQ) linked to a computerised record. A weighted numerical score (WNS) was derived for each patient. Patients underwent flexible sigmoidoscopy, a diagnostic outcome was recorded and later Dukes’ stage appended. Early and advanced colorectal cancers were separated and PCQ derived symptom profiles compared. Chi-square, Fisher exact, Student’s t-test and logistic regression were used for statistical analysis. RESULTS A total of 183 patients had cancer, 55 (30%) were Dukes’ A early colorectal cancers, 112 were advanced colorectal cancers (Dukes’ B‐D) and 16 could not be staged. Early colorectal cancers had significant symptoms and comparable profile to advanced colorectal cancers. The tendency in advanced colorectal cancers was towards greater symptom prevalence for only a few primary and systemic symptoms, as reflected by a higher WNS of 75 (P = 0.001) CONCLUSIONS Early colorectal cancers do have significant symptoms which can easily be captured by a PCQ and objective scoring tool in the secondary care setting. Detection of these cancers has the potential to improve survival.

Treatment of Non-Endemic Hepatolithiasis in a Western Country. The Role of Hepatic Resection

Abstract: INTRODUCTION The aim of this study was to assess the safety and the efficacy of hepatic resective surgery in the treatment of single lobe hepatolithiasis. PATIENTS AND METHODS Retrospective analysis and comparison between hepatic resections in patients with hepatolithiasis (hepatolithiasis group [HG]) and liver masses (control group [CG]). Seventeen consecutive Caucasian patients with single lobe hepatolithiasis (HG) and 30 patients with liver masses without chronic liver disease and previous chemotherapy (CG), were operated during the 5-year period 2000‐2005, inclusive. Major hepatic resections including 4 right hepatectomies, 10 left hepatectomies, and 3 left lateral sectionectomy in HG, and 12 right hepatectomies, 3 extended right hepatectomy, 5 left hepatectomies, 4 left lateral sectionectomy, 5 bisegmentectomy, and 1 mesohepatectomy in CG. The main outcome measures were: type and length of surgical procedures, intra- and postoperative blood losses and transfusions (packed red blood cells [PRBC] and fresh frozen plasma [FFP]), intra- and postoperative course and complications (within 30 days of the operation), length of hospitalisation, histopathology, and recurrence of hepatolithiasis. RESULTS Mean operation time was 6.21 ± 2.38 h in HG versus 7.10 ± 2.21 h in CG (P = 0.33). Mean intra-operative blood loss in CG was higher than in HG (1010 ± 550 ml versus 560 ± 459 ml; P = 0.035). The other variables considered in the two groups were not statistically different. Intra-operative transfusion were 0.50 ± 0.85 units in HG versus 1.35 ± 2.25 units of PRBC in CG (P = 0.06), and 0.66 ± 1.34 units in HG versus 0.68 ± 1.20 units of FFP in CG (P = 0.44), respectively. No cases of death were registered. Postoperative complications occurred in 12 patients (25.5%) ‐ 5 cases (10.6%) in HG and 7 cases (14.8%) in CG (P = 0.18). Mean postoperative transfusions were 0.47 ± 1.24 units in HG versus 1.10 ± 1.18 units of PRBC in CG (P = 0.35), and 0.65 ± 1.40 units in HG versus 0.46 ± 0.82 units of FFP in CG (P = 0.25), respectively. Difference in median hospitalisation was not statistically significant (14 ± 10 days versus 12 ± 9 days; P = 0.28). Histopathology showed cholangiocarcinoma in 2 cases (11.7%). During the followup period (range, 5‐127 months; mean, 50.4 ± 41.9 months), 1 patient had lithiasis recurrence and 1 patient died for the co-existing cholangiocarcinoma. CONCLUSIONS Hepatic resection is the treatment of choice in patients with single lobe hepatolithiasis. An early indication for surgery may reduce the mortality/morbidity rates of hepatic resection for hepatolithiasis.

Trends in elective hand surgery referrals from primary care.

Abstract: INTRODUCTIONTwo prospective audits of activity in a hand unit were performed, in 1989–1990 and during 2000–2001, to identify trends in elective hand surgery referrals from primary care PATIENTS AND METHODSTwo 6-month prospective audits of activity in a hand unit were performed, including elective referrals from primary care Data were collected on all in-district referrals with elective hand disorders Cross boundary flow was identified to permit assessment of changes in referrals by diagnosis over a decade RESULTSThere was a 36% increase in health authority referrals for elective hand surgery over the decade (from 289 to 392 per 100,000 of population per year) The number of elective hand surgery operations rose 34% over the decade (from 149 to 199 operations per 100,000 of population per year) Carpal tunnel syndrome (the commonest reason for elective referral) almost doubled (from 597 to 112 per 100,000 of population per year) Referrals for ganglion, the second most common elective referral, rose m

The Extended Scope Physiotherapist in Orthopaedic Out-Patients – An Audit

Abstract: INTRODUCTIONWe undertook an audit of the activity of the extended scope physiotherapists (ESPs) in our unit. We assessed their activity against three benchmark data: (i) independent assessment and management by the ESP of 85% of patients seen by them; (ii) no patient to be re-referred to a surgeon with the same problem; and (iii) patient satisfaction rate of 89%. PATIENTS AND METHODSAll new referrals seen by the ESPs over the 6-month period between July 2002 and December 2002 were included in the audit. Patient medical records were reviewed retrospectively. Patients were contacted by telephone 12 months after their initial clinic appointment to obtain patient satisfaction scores. RESULTSIn the 6-month period, 150 patients (75 male, 75 female) were seen. Their median age was 43.5 years (range, 17–85 years). Their main complaints related to the spine (42%), knee (33%), shoulder (18%), or other site (7%). The ESPs saw and managed 82/150 patients (55%) independently. Consultant review was required for 81% of ...

Forgotten Digital Tourniquet: Salvage of an Ischaemic Finger by Application of Medicinal Leeches

Abstract: Individual finger tourniquets are appropriate to the management of a wide range of conditions presenting to an accident and emergency department. They are simpler and more comfortable to use than upper arm pneumatic tourniquets and commercially available digital tourniquets are not readily available in the accident and emergency unit. However, if a finger tourniquet is overlooked, ischaemia of the digit results, and gangrene may follow if the problem is not defused early enough, leading to potential disaster.1–3 We present one case where a digit was salvaged after 4 days of tourniquet application, using medicinal leeches.

Re-Admission Rates within 28 Days of Total Hip Replacement

Abstract: INTRODUCTIONThe aim of the study was to identify the reasons for the higher than expected emergency re-admission to hospital within 28 days of total hip replacement (THR) for Stepping Hill Hospital...

Radiofrequency Ablation (RFA) as A Cytoreductive Strategy for Hepatic Metastasis from Breast Cancer

Abstract: INTRODUCTIONPatients with liver metastasis from breast cancer have a poor prognosis, although this may be improved by hepatectomy in a selected group with disease confined to the liver. We evaluate the effectiveness of radiofrequency ablation (RFA) as a cytoreductive strategy in the management of liver metastasis from primary breast cancer. PATIENTS AND METHODSNineteen patients with hepatic metastasis from primary breast cancer underwent RFA of their liver lesions between April 1998 and August 2004. RESULTSThe median age of the patients was 52 years (range, 32–69 years), 8 had disease confined to the liver, with 11 having stable extrahepatic disease in addition. Seven patients with disease confined to the liver at presentation are alive, as are 6 with extrahepatic disease, median follow-up after RFA was 15 months (range, 0–77 months). Survival at 30 months was 41.6%. In addition, 7 patients followed up for a median of 14 months (range, 2–29 months) remain alive and disease-free. RFA failed to control hepa...

From Meeting Presentation to Peer-Review Publication – a UK Review

Abstract: INTRODUCTION Annual academic surgical meetings provide a forum for the discussion of research. For the wide-spread dissemination of this information, peer-reviewed publication is required. The aim of this study was to compare the amount of presentations which go on to publication from 4 UK-based surgical meetings. MATERIALS AND METHODS We determined whether a presentation had led to a successful publication using PubMed, a median of 28 months following each meeting. We compared the ASGBI publication rate with the meetings of the Vascular Surgical Society (VSSGBI), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Transplantation Society (BTS). We also compared the median impact factor of journals used. RESULTS The ASGBI and BTS had a similar rate of presentations resulting in publication, with 35% and 36% at 2 years, respectively. The VSS had a significantly greater proportion of presentations resulting in publication (54% at 2 years; P = 0.004), whilst the ACPGBI had significant fewer (24% at 2 years; P = 0.006). There was no difference in the median impact factors of the journals used between the meetings (Kruskal Wallis P = 0.883). CONCLUSIONS There is a significant variation between meetings in terms of turning presentations into publications. However, the majority of abstracts have still not been fully published within 2 years of presentation at the meeting.

Publication of surgical abstracts in full text: a retrospective cohort study.

Abstract: INTRODUCTIONs presented at national and international scientific meetings are an important educational resource. However, the work is not peer reviewed and little is known about the quality or validity of the presented results and the fate of such abstracts. MATERIALS AND METHODSThis is a retrospective cohort study of abstracts presented to the 1997 annual meeting of the Association of Surgeons of Great Britain and Ireland. We examined the rates of full-text publication, time to publication, factors influencing publication, inconsistencies between presented and subsequently published manuscripts, and reasons for non-publication of abstracts. RESULTSOf the 241 abstracts presented, 136 (56.4%) were published at a median duration of 18 months. Multicentre studies had a greater tendency to subsequent publication and studies involving academic centres predicted publication in a high impact factor journal. Inconsistencies between presented and published abstracts were common and were significantly assoc...

Perceptions of the application of fast-track surgical principles by general surgeons.

Abstract: INTRODUCTIONFast-track surgery is a novel approach which uses a multimodal package of changes to traditional surgical care to reduce the stress response evoked by surgery allowing for enhanced recovery times. The depth of understanding and application of fast-track principles to general surgical practice by consultant surgeons is unknown. MATERIALS AND METHODS‘Core management features’ central to published fast-track general surgical studies were identified following a comprehensive Medline literature search. The knowledge and application of these features were examined in a postal questionnaire sent to 116 general surgeons in a single region. RESULTSOf respondents, 31% indicated they were currently using fast-track surgery (the ‘fast-trackers'). The number of fast-track compliant responses was calculated for each consultant (range, 1–12 of 14). Mean scores for ‘fast-trackers’ of 8.45 (± 2.188) and ‘non-fast-trackers’ of 6.16 (± 2.352) showed no significant differences (P > 0.6). The ‘fast-trackers’ media...

Survey of the Management of Acute Traumatic First-Time Anterior Shoulder Dislocation Among Trauma Clinicians in the UK

Abstract: INTRODUCTIONThe aim of this work was to survey how acute traumatic first-time anterior shoulder dislocation (AFSD) is managed among trauma clinicians in UK using a postal questionnaire. PATIENTS AND METHODSA total of 150 questionnaires were sent out to active consultant members of the British Trauma Society in the UK. Questions were laid out in two ‘workgroups’. In Workgroup One, an assortment of questions was included regarding choices and methods of analgesia, methods of monitoring used, methods of reduction, and position of immobilisation. In Workgroup Two, three different case scenarios were analysed to look into the ‘post-reduction’ management. RESULTSThe response rate was 60%. Of respondents, 22% have a local protocol for managing AFSD. Almost all respondents recommended pre- and post-reduction X-rays as standard practice. Most respondents favoured systemic analgesia and sedation with airways' monitoring, as opposed to intra-articular anaesthesia (68 versus 9). Eighty-four respondents advocated immo...

The positive predictive value of diagnostic ultrasound for occult herniae.

Abstract: INTRODUCTIONThe aim of this study is to ascertain the accuracy of diagnostic ultrasound in the assessment of the occult abdominal and groin herniae. The authors have previously demonstrated its efficacy in diagnosing the type of clinical groin herniae but occult herniae provide a further diagnostic problem. PATIENTS AND METHODSA total of 113 consecutive patients were referred prospectively for ultrasound examinations with clinically suspected occult herniae. All positive scans were offered surgery whilst the negative results were offered further imaging or other diagnostic tests depending on the clinical criteria. The end point for negative scans was based on 18-month follow-up or resolution of symptoms. RESULTSOverall, 59 scans showed positive results for herniae and 56 of these had surgery. In the other three patients, two refused an operation, and one had no hernia detected at operation. In the remaining 57 scans, ultrasound offered alternative soft tissue diagnoses in 23 patients and surgical/endoscop...

Centralisation of oesophagogastric cancer services: can specialist units deliver?

Abstract: INTRODUCTIONOesophagogastric cancer surgery is increasingly being performed in only centralised units. The aim of the study was to examine surgical outcomes and service delivery within a specialist unit. PATIENTS AND METHODSThe case notes of all patients undergoing attempted oesophagogastrectomy between January 2000 and May 2003 were identified from a prospective consultant database. RESULTSA total of 187 patients (median age, 63 years; range, 29–83 years; M:F ratio, 3.9:1) underwent attempted oesophagogastrectomy. Of these, 91% were seen within 2 weeks of referral and treatment was instituted after a mean of 31 days (range, 1–109 days). More patients underwent surgery (63%) than neoadjuvant therapy (56%) within 1 month of referral. The main indication for surgery was invasive malignancy in 166 patients (89%). The 30-day mortality was 0.5% (1 death) and in-hospital mortality was 1.1% (2 deaths). The median length of hospital stay was 14 days (range, 7–69 days). Significant postoperative morbidity included...