ANZ journal of surgery
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ANZ journal of surgery · Nov 2015
Prognostic molecular markers in head and neck squamous cell carcinoma in a New Zealand population: matrix metalloproteinase-2 and sialyl Lewis x antigen.
The survival rate for head and neck squamous cell carcinoma (HNSCC) is among the lowest of the major cancers and has not substantially improved in the past two decades. Tumours with similar histological features may have widely differing clinical outcomes and thus identification of prognostic and predictive biomarkers may be valuable for determining appropriate clinical management strategies. The objective of this study was to establish the prognostic significance of six molecular markers in HNSCC in a New Zealand population: matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), tissue inhibitor of matrix metalloproteinase-1, sialyl Lewis antigens a and x (sLe(a) , sLe(x) ) and alpha B-crystallin. ⋯ MMP-2 and sLe(x) were negative prognostic markers for survival in these HNSCC patients. This offers opportunities for clinical trials to reduce the risk of nodal and distant metastases through blocking tumour cell adhesion to endothelium.
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ANZ journal of surgery · Nov 2015
Changes in the management of deep sternal wound infections: a 12-year review.
Deep sternal wound infection (DSWI) is a rare but life-threatening complication following cardiac surgery associated with increased morbidity and mortality. Management of these patients has evolved over the years and can include sternal rewiring, mediastinal irrigation, negative-pressure wound therapy (NPWT) dressing or repair with flaps. We reviewed changes in our management of DSWI and outcomes. ⋯ The use of NPWT dressings as a bridge to definitive closure may reduce the need for more burdensome flap reconstruction, does not delay definitive reconstruction or prolong hospital stay and may reduce post-reconstruction complications requiring re-operation.
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ANZ journal of surgery · Nov 2015
Index cholecystectomy in grade II and III acute calculous cholecystitis is feasible and safe.
According to the Tokyo Guidelines, recommendation on management of moderate and severe cholecystitis are cholecystostomy in severe cases and either cholecystostomy or emergency cholecystectomy in moderate cases depending on surgical experience. The rationale for this is that percutaneous cholecystostomy is a short procedure while laparoscopic cholecystectomy may be associated with a larger physiological insult. The aim of this study was to determine the safety and efficacy of cholecystectomy in moderate and severe acute calculous cholecystitis (ACC) at our institution. ⋯ Index cholecystectomy is feasible with low morbidity and no mortality even in severe ACC. Emergency cholecystectomy in the setting of severe cholecystitis appear to be safe and technically feasible option.