Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Feb 2021
Safe surgical tracheostomy in patients with COVID-19: key clinical considerations.
Surgical tracheostomy is a high aerosol-generating procedure that is an essential aid to the recovery of patients who are critically ill with COVID-19 pneumonia. We present a single-centre case series of 16 patients with COVID-19 pneumonia who underwent tracheostomy. We recommend that the patient selection criteria for achieving a favourable outcome should be based on fraction of inspired oxygen together with prone-position ventilation. ⋯ Timely tracheostomy also leads to an earlier freeing up of ventilator space during a period of a rapidly escalating pandemic. The outcomes in terms of swallow and speech function were also assessed. The study has also helped to remove the anxiety around open a tracheostomy in patients who are COVID-19 positive.
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Ann R Coll Surg Engl · Feb 2021
Observational StudyThe effect of the COVID-19 pandemic on mental health associated trauma, admissions and fractures at a London major trauma centre.
Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. ⋯ While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.
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Ann R Coll Surg Engl · Jan 2021
Case ReportsAcute hyperparathyroid crisis: ectopic submandibular parathyroid gland the culprit.
Parathyroid exploration via a focused approach or bilateral neck exploration should be considered in the management of all types of hyperparathyroidism. Eutopic and ectopic, single or multiple glands can pose challenges to the surgeon and available preoperative imaging modalities may not be equally applicable or appropriate in all cases. We report an interesting case of parathyroid surgery where the patient presented with a rare ectopic adenoma in the form of a hyperparathyroid crisis.
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Ann R Coll Surg Engl · Nov 2020
Case ReportsMassive liver haemangioma causing Kasabach-Merritt syndrome in an adult.
Liver haemangiomas are common, but their size very rarely exceeds 40cm. Most people with liver haemangiomas are asymptomatic, and diagnosis is usually made incidentally during imaging for other complaints. When a liver haemangioma is symptomatic or produces complications, surgical intervention may be warranted. ⋯ We report the case of a 32-year-old woman with a 42 × 32 × 27cm (18,870ml) liver haemangioma associated with Kasabach-Merritt syndrome. The diagnosis was challenging, even with proper imaging, owing to the rarity of the condition. It was achieved with an exploratory laparotomy with biopsy.
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Ann R Coll Surg Engl · Nov 2020
Prophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy could reduce the frequency of portomesenteric venous thrombosis.
Portal and mesenteric venous thrombosis is a rare but potentially serious complication after laparoscopic sleeve gastrectomy. There are no consistent studies that prove the safety and effectiveness of oral anticoagulant thromboprophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy. The objective was to evaluate the effect of rivaroxaban on the frequency of portal and mesenteric venous thrombosis and its safety profile after laparoscopic sleeve gastrectomy. ⋯ Thromboprophylaxis during the whole hospital stay (two to three days), followed by rivaroxaban 10mg once daily for 10 days after discharge (completing in total 13-14 days of prophylaxis), could reduce cases of post-surgical portal and mesenteric venous thrombosis without an increase in bleeding complications.