Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Mar 2019
Comparative StudyThe role of core needle biopsies in the management of neck lumps.
King's College Hospital has proudly provided a one-stop neck lump clinic since 2012. These multidisciplinary clinics allow for rapid diagnoses due to in-clinic investigations. In April 2013, ultrasound-guided core needle biopsies were introduced as an alternative/adjunct to fine-needle aspiration cytology and open biopsies for obtaining histological diagnoses. The aim of the study was to assess the impact of core needle biopsies on the diagnosis of neck lumps compared with fine-needle aspiration cytology and open biopsies between April 2015 and May 2016. ⋯ The introduction of core needle biopsies has reduced the number of open biopsies performed. With increasing acceptance of this minimally invasive technique, core needle biopsies appear to be forming the key diagnostic investigation in patients with neck lumps.
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Ann R Coll Surg Engl · Sep 2018
Case ReportsManagement of a temporomandibular joint synovial cyst in a case complicated by severe trigeminocardiac reflex.
The trigeminocardiac reflex is a rare occurrence in patients undergoing maxillofacial surgery, with a reported incidence of 1-2%. Clinical signs and symptoms include bradycardia, nausea, with further stimulation potentially leading to cardiac dysrhythmias, ectopic beats, atrioventricular blocks and asystole. ⋯ We report the first case of a tender temporomandibular joint synovial cyst whose management was complicated by severe trigeminocardiac reflex resulting in asystole. We suggest that in such cases communication between surgeons and the anaesthesia team is of paramount importance and informing the anaesthetist intraoperatively prior to the manipulation of the capsule or temporomandibular joint meniscus is recommended in the prevention or successful treatment of this condition.
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Ann R Coll Surg Engl · Sep 2018
Compliance with enhanced recovery protocols in elderly patients undergoing colorectal resection.
Introduction Enhanced recovery after surgery (ERAS) is associated with reduced length of stay (LOS) and improved outcomes in colorectal surgery. It is unclear whether ERAS can be safely implemented in elderly patients undergoing complex colorectal resections. The aim of this study was to evaluate the feasibility of ERAS in patients of all ages undergoing colorectal surgery. ⋯ Factors predictive of morbidity on multivariate analysis comprised conversion to open surgery (OR: 7.72, p=0.004), high creatinine (OR: 1.03 per unit increase in creatinine, p=0.008) and stoma education (OR: 0.31, p=0.030). Conclusions ERAS can be successfully implemented in older patients. There was equal compliance with the ERAS programme across the four age groups and no significant effect of age on LOS or morbidity.
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Ann R Coll Surg Engl · Jul 2018
Polymeric clips are a quicker and cheaper alternative to endoscopic ligatures for securing the appendiceal stump during laparoscopic appendicectomy.
Introduction The use of polymeric clips in securing the appendiceal stump has been increasingly reported as a viable alternative to current methods in emergency laparoscopic appendicectomy. We evaluated the operative outcomes following the use of polymeric clips versus endoscopic ligatures. The primary endpoint was operative time, with secondary outcomes including complications, inpatient stay, and cost analysis. ⋯ The use of polymeric clips cost £21 compared with £49 for endoloops per operation, which rose to £70 if both clips and endoloops were used during the procedure. Discussion Polymeric clips are a safe, viable and economical method for securing the appendiceal stump during laparoscopic appendicectomy. The clinical significance of nine minutes of reduced operating time in the polymeric clip cohort warrants further study with an adequately powered randomised controlled trial.