Irish journal of medical science
-
The national early warning score (NEWS) was developed to detect the early signs of patient deterioration with a view to instituting higher levels of care. There is a concern about the sensitivity of the NEWS score in patients with chronic hypoxaemic conditions. ⋯ In medical patients admitted to a Model 2 hospital with chronic respiratory illness, the 'respiratory variables' of the NEWS score are poor discriminators of patients who are clinically deteriorating. Better tools (such as the CREWS score) are required to distinguish acutely ill from chronically ill patients with respiratory disease in Model 2 hospitals.
-
Somatosensory-evoked potentials (SSEPs) are widely used for intraoperative spinal cord monitoring. Although many general anesthetics inhibit SSEPs, etomidate has been reported to boost SSEPs. This clinical study aimed to test whether etomidate doses less than 0.3 mg/kg amplify SSEP monitoring. ⋯ Small doses of etomidate that were less than 0.3 mg/kg had dose-related amplification effects on SSEP monitoring.
-
Endovascular repair (EVAR) for large abdominal aortic aneurysm (AAA) in anatomically suitable patients is associated with low early mortality and morbidity. However, EVAR is associated with a significant risk of late complication and a high cumulative re-intervention rate. Many large experienced centres have offered complex EVAR to challenging aortic anatomies such as abdominal aorto-iliac aneurysm (AAIA). We hypothesised that complex EVAR, for AAIA, would be associated with an increased risk of late graft-related complications. ⋯ EVAR can be carried out with low early mortality but has a significant risk of late complication, the commonest of which is endoleak. Complex EVAR for abdominal aorto-iliac aneurysm can be carried out with comparable results to conventional EVAR. However, high rates of persistent endoleak and inferior mesenteric artery patency, and lack of aneurysm sac shrinkage, would suggest they may be at increased risk of late complications and may benefit from enhanced and extended radiological surveillance.
-
A retrospective analysis of oesophageal thickening diagnosed as an incidental finding at Computed Tomography (CT) with endoscopic and histological correlation. ⋯ Endoscopic evaluation is recommended for incidental oesophageal thickening detected at Computed Tomography to exclude underlying malignancy.
-
Sentinel lymph node (SLN) positivity is an important prognostic factor in cutaneous melanoma. A nomogram has been developed at Memorial Sloan-Kettering Cancer Centre (MSKCC) to predict SLN positivity and this may be useful to select patients for SLN biopsy. ⋯ This nomogram is valid and accurate at predicting SLN positivity in an Irish population. This may facilitate the clinical decision to perform a SLN biopsy in malignant melanoma.