Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Mar 2012
Case ReportsAn unusual case of desmoid tumour presenting as haemorrhagic shock.
We report the case of a 22-year-old patient who presented to the emergency department with epigastric pain and vomiting. Haematological studies showed a rapid decrease in haemoglobin levels from 13.6 g/dl to 4.9 g/dl. ⋯ An intra-abdominal desmoid tumour presenting as a hemorrhagic shock has not previously been described. Given the relatively benign course of the disease and the young age at presentation, this clinical entity should not be overlooked as it has the potential to invade vessels and therefore be fatal.
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Ann R Coll Surg Engl · Mar 2012
Case ReportsAn unusual presentation of late oesophagojejunal anastomotic leak after total D2 gastrectomy.
Oesophagojejunal anastomotic leak usually presents in the early post-operative period with abdominal pain and sepsis. We report a case of late anastomotic leak presenting as epigastric pain with hyperamylasaemia and discuss the differential diagnosis.
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Although there are two types of LA, amides are now more commonly used. Understanding the pharmacology and physicochemical properties of LAs enables prediction of speed of onset, duration of action and determination of the correct LA for a particular clinical requirement. Drug concentration is expressed as a percentage such that 1% = 1 g/100 ml = 1,000 mg/100 ml = 10 mg/ml. Lipid rescue therapy has been shown to be a very effective treatment for LA toxicity.
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Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires. ⋯ Despite manufacturer's instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring.
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Ann R Coll Surg Engl · Jan 2012
Accuracy of prognostic scores in decision making and predicting outcomes in metastatic spine disease.
Management of metastatic spinal disease has changed significantly over the last few years. Different prognostic scores are used in clinical practice for predicting survival. The aim of this study was to assess the accuracy of prognostic scores and the role of delayed presentation in predicting the outcome in patients with metastatic spine disease. ⋯ The prognostic scoring systems are not uniformly effective in all types of primary tumours. However, they are useful in decision making for surgical intervention, taking other factors into account, in particular the age of the patient, the type and stage of the primary tumour and general health.