Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Mar 2013
Radiological and clinical examination in the diagnosis of Spigelian hernias.
Spigelian hernia are rarely reported lateral abdominal wall hernias. Clinical diagnosis of a suspected hernia can be challenging owing to vague presenting symptoms and signs. This study aimed to investigate the accuracy of preoperative imaging and clinical examination in the diagnosis of Spigelian hernias. ⋯ This study shows that ultrasonography and CT have a high sensitivity and PPV in relation to occult Spigelian hernias. When no obvious Spigelian hernia is present, patients should be evaluated with radiological investigation to establish a diagnosis. Owing to diagnostic uncertainty, a laparoscopic approach should be favoured.
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Retained sponges and instruments (RSI) due to surgery are a recognised medical 'never event' and have catastrophic implications for patients, healthcare professionals and medical care providers. The aim of this review was to elucidate the extent of the problem of RSI and to identify preventative strategies. ⋯ Vigilance among operating theatre personnel is paramount if RSI is to be prevented. Prospective multicentre trials to assess efficacy of new technologies aiding manual counting should be undertaken if this medical error is to be eliminated completely.
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Ann R Coll Surg Engl · Mar 2013
Case ReportsTraumatic diaphragmatic hernia: delayed presentation with tension viscerothorax--lessons to learn.
Diaphragmatic rupture is a serious complication of thoracoabdominal trauma. The condition may be missed initially. ⋯ His diaphragmatic injury passed unnoticed, to present two years later with left tension viscerothorax, a rarely reported and hardly recognised entity. Nasogastric tube insertion aborted the emergency situation and the hernia was repaired successfully in a semielective setting.
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Ann R Coll Surg Engl · Mar 2013
Cardiopulmonary exercise testing as a predictor of complications in oesophagogastric cancer surgery.
An anaerobic threshold (AT) of <11 ml/min/kg can identify patients at high risk of cardiopulmonary complications after major surgery. The aim of this study was to assess the value of cardiopulmonary exercise testing (CPET) in predicting cardiopulmonary complications in high risk patients undergoing oesophagogastric cancer resection. ⋯ This study has shown a correlation between AT and the development of cardiopulmonary complications although the discriminatory ability was low.
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Ann R Coll Surg Engl · Mar 2013
Thoracic surgical management of colorectal lung metastases: a questionnaire survey of members of the Society for Cardiothoracic Surgery in Great Britain and Ireland.
Distant metastases to liver and lung are not uncommon in colorectal cancer. Resection of metastases is accepted widely as the standard of care. However, there is no firm evidence base for this. This questionnaire survey was carried out to assess the current practice preferences of cardiothoracic surgeons in Great Britain and Ireland. ⋯ The results confirm that the majority of respondents use conventional cross-sectional imaging and either VATS or formal thoracotomy for resection. The results emphasise the continuing need for formal randomised trials to provide evidence of any survival benefit from pulmonary metastasectomy for colorectal lung metastases.