The New Zealand medical journal
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To review the management of acute gallstone disease at a provincial New Zealand centre and compare to current national/international practice. ⋯ Nelson Hospital has a low rate of index cholecystectomy. High numbers of patients represent to the emergency department or are readmitted whilst waiting for definitive surgery. Patients presenting with gallstone pancreatitis fail to receive treatment in accordance with international management guidelines.
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In 2005, the senior author (AGH) initiated an Enhanced Recovery After Surgery (ERAS) or 'fast-track' programme for elective colonic surgery at the Manukau Surgery Centre aimed at improving perioperative care. We reviewed the senior author's experience of elective colectomy conducted within the ERAS programme and evaluated clinical outcomes. ⋯ In one surgeon's experience, elective colectomy performed within an optimised perioperative care environment achieves shorter hospital stay with a low rate of major complications.
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A 50-year-old lady presented with chest pain, tremor, weight loss and intermittent ST elevation in her ECG associated with elevated markers of myocardial injury. She was diagnosed with Graves' disease and coronary angiogram showed normal coronary arteries. ⋯ She was successfully treated with diltiazem, metoprolol and carbimazole. This case highlights the importance of considering hyperthyroidism in the diagnosis of chest pain with normal coronary arteries.