Index cholecystectomy: a continuing challenge for a provincial hospital.

Aims: To review the management of acute gallstone disease at a provincial New Zealand centre and compare to current national/international practice.

Methods: All patients presenting to Nelson Hospital with acute gallstone-related pathology were identified from the study period. The first presentation within the audit period was defined as the index admission.

Isolated melanoma metastasis to stomach with possible regressed primary lesion: the importance of pursuing solitary melanoma metastases.

This is a case of a 60-year-old man who presented with anaemia and was subsequently diagnosed with a solitary 5 cm malignant melanoma metastasis of the gastric fundus. No primary lesion was identified. After surgical resection he is alive at 5 years follow-up, adding weight to the notion that solitary melanoma metastases should be aggressively pursued, as long-term survival is possible.

Rectus sheath catheters for continuous analgesia after upper abdominal surgery.

The segmental nerves T6-T11 pass through and innervate the rectus abdominis muscle and overlying skin. The arcuate lines compartmentalize the rectus, but they are deficient posteriorly and hence a catheter tunnelled into the posterior sheath can be used to achieve an effective continuous analgesic block. Volume is important to fill the compartment.