Radical total pelvic exenteration with concomitant right nephrectomy in the management of recurrent endometrioid ovarian adenocarcinoma: A case report and literature review.

Endometrioid ovarian adenocarcinoma is a common subtype of epithelial ovarian cancer that can arise on a background of endometriosis. Maximal cytoreductive effort with an aim to remove all macroscopic disease (achieve R0) is the single independent prognostic factor for survival. Complex multidisciplinary surgeries may be required in order to achieve this.

The role of multidisciplinary team and stepwise pelvic devascularization to minimize blood loss during total pelvic exenteration for patients refusing blood transfusion.

Key Clinical Message: Radical gynecology oncology surgeries are feasible in patients refusing blood transfusion, when performed with careful preoperative (with hemoglobin optimization and patients' counseling), intraoperative (with hemostasis and stepwise devascularization, hemodilution, and autologous cell salvage) and postoperative (considering iron infusion or erythropoietin) planning with a multidisciplinary team involvement.

Abstract: We describe the case of a female Jehovah's Witness patient in her 60s undergoing pelvic exenteration, focusing on the preoperative, intraoperative, and postoperative measures that allowed an uncomplicated surgery without blood transfusion. Blood transfusions are common in the surgical management of gynecology oncology patients, up to 93% of patients undergoing pelvic exenteration may require blood products.

The impact and restoration of colorectal services during the coronavirus disease 2019 pandemic: A view from Oxford.

Aim: The coronavirus pandemic has significantly disrupted the way we deliver healthcare worldwide. We have been flexible and creative in order to continue providing elective colorectal cancer operations and to restart services for benign cases during the recovery period of the pandemic. In this paper, we describe the impact of coronavirus on our elective services and how we have implemented new patient pathways to allow us to continue providing patient care.

Maintaining Standards in Colorectal Cancer Surgery During the Global Pandemic: A Cohort Study.

Aim: Cancer surgery in the COVID-19 pandemic presents many new challenges. For each patient, the risk of contracting COVID-19 during the perioperative period, with the potential for life-threatening sequelae (1), has to be weighed against the risk of delaying treatment. We assessed the response and short-term outcomes from elective colorectal cancer surgery during the pandemic at our institution.

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey.

Aim: This study aimed to survey consultants' experience of working as or with emergency general surgery (EGS) surgeons and to investigate the role they fulfil in the management of general and subspeciality emergencies.

Method: An electronic survey, designed to capture both quantitative and qualitative data, was piloted and then circulated to members of the Association of Coloproctology of Great Britain and Ireland.

Results: Two hundred and forty-two responses were received from 848 recipients (a 29% response rate) covering 104 of 135 (77%) acute NHS Trusts in England.

60 seconds to survival: A pilot study of a disaster triage video game for prehospital providers.

Introduction: Disaster triage training for emergency medical service (EMS) providers is not standardized. Simulation training is costly and time-consuming. In contrast, educational video games enable low-cost and more time-efficient standardized training.

Reliability in the process of care during emergency general surgical admission: A prospective cohort study.

Introduction: Emergency general surgery (EGS) is responsible for 80-90% of surgical in-hospital deaths and the early management of these unwell patients is critical to improving outcomes. Unfortunately care for EGS patients is often fragmented and important care processes are frequently omitted.

Methods: This study aimed to define a group of important processes during EGS admission and assess their reliability.

Mortality in high-risk emergency general surgical admissions.

Background: There is increasing evidence of variable standards of care for patients undergoing emergency general surgery in the National Health Service (NHS). The aim of this study was to quantify and explore variability in mortality amongst high-risk emergency general surgery admissions to English NHS hospital Trusts.

Methods: The Hospital Episode Statistics (HES) database was used to identify high-risk emergency general surgery diagnoses (greater than 5 per cent national 30-day mortality rate).

A systematic review regarding the feasibility and safety of endoscopic full thickness resection (EFTR) for colonic lesions.

Purpose: This review summarizes the published methods of colonic EFTR, examining data on feasibility and safety. Due to the introduction of bowel cancer screening programs, there is an increasing incidence of complex colonic polyps and early colonic cancer that requires segmental colectomy. Traditional radical surgery is associated with significant morbidity, and there is a need for alternative treatments.

Use of antibiotic prophylaxis in elective inguinal hernia repair in adults in London and south-east England: a cross-sectional survey.

Purpose: Evidence regarding whether or not antibiotic prophylaxis is beneficial in preventing post-operative surgical site infection in adult inguinal hernia repair is conflicting. A recent Cochrane review based on 17 randomised trials did not reach a conclusion on this subject. This study aimed to describe the current practice and determine whether clinical equipoise is prevalent.

Training faculty in nontechnical skill assessment: national guidelines on program requirements.

Objective: To develop guidelines for a faculty training program in nontechnical skill assessment in surgery.

Background: Nontechnical skills in the operating room are critical for patient safety. The successful integration of these skills into workplace-based assessment is dependent upon the availability of faculty who are able to teach and assess them.

An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery.

Objective: To investigate the nature of process failures in postoperative care, to assess their frequency and preventability, and to explore their relationship to adverse events.

Background: Adverse events are common and are frequently caused by failures in the process of care. These processes are often evaluated independently using clinical audit.

An observational study of teamwork skills in shift handover.

Background: Clinical handover (handoff, sign out) is frequently implicated as a cause of adverse events in hospitalised patients. Complex social interactions such as handover are subject to the teamwork skills of the participants and there is increasing evidence that the quality of teamwork in handover affects outcome. Teamwork skills have been assessed in one-to-one handovers but the applicability of these measurement tools to healthcare team shift handovers remains unproven.

Laparoscopic revision of failed antireflux surgery: a systematic review.

Background: Laparoscopic antireflux surgery is an accepted treatment for persistent gastroesophageal reflux but about 4% of patients will eventually require revision surgery.

Methods: We searched The Cochrane Collaboration, Medline, and EMBASE databases, augmented by Google Scholar and PubMed related articles from January 1, 1990, to November 22, 2010. Twenty studies met the inclusion criteria, reporting on 930 surgeries.

Do male desert gobies compromise offspring care to attract additional mating opportunities?

Males often play a critical role in offspring care but the time and energy invested in looking after young can potentially limit their ability to seek out additional mating opportunities. Recent studies, however, suggest that a conflict between male parental effort and mating effort may not always be inevitable, especially if breeding occurs near the nest, or if parental behaviours are under sexual selection. Accordingly, we set out to experimentally investigate male care and courtship in the desert goby Chlamydogobius eremius, a nest-guarding fish with exclusive paternal care.

The management of abdominal aortic aneurysms.

Abdominal aortic aneurysms cause about 6000 deaths per year in England and Wales, predominantly from rupture. Significant progress has been made in recent years in developing minimally invasive, endovascular methods of treatment. This review evaluates the current management options for abdominal aortic aneurysm.

Padé approximation in time-domain boundary conditions of porous surfaces.

Formulation and implementation of time-domain boundary conditions (TDBCs) at the surface of a reactive porous material are made challenging by the slow decay, complexity, or noncausal nature of many commonly used models of porous materials. In this paper, approaches are described that improve computational efficiency and enforce causality. One approach involves approximating the known TDBC for the modified Zwikker-Kosten impedance model as a summation of decaying exponential functions.

Equations for finite-difference, time-domain simulation of sound propagation in moving inhomogeneous media and numerical implementation.

Finite-difference, time-domain (FDTD) calculations are typically performed with partial differential equations that are first order in time. Equation sets appropriate for FDTD calculations in a moving inhomogeneous medium (with an emphasis on the atmosphere) are derived and discussed in this paper. Two candidate equation sets, both derived from linearized equations of fluid dynamics, are proposed.

Expression of class-3 semaphorins and their receptors in the neonatal and adult rat retina.

Purpose: Semaphorins comprise a family of molecules that influence the growth and guidance of neuronal processes. Class-3 semaphorins are secreted proteins, and their effects are mediated by neuropilin (NP) and plexin (Plx) receptors. There is considerable information on mechanisms that influence axonal guidance and plasticity in the mammalian visual system, but a role for semaphorins has received less scrutiny.

Effect of a standardized pharyngitis treatment protocol on use of antibiotics in a pediatric emergency department.

Background: Pharyngitis is a common complaint in pediatric patients. If clinical parameters are used alone, bacterial pathogens will be wrongly implicated in many cases. A nonstandardized approach to the treatment of children with pharyngitis in an emergency department setting may lead to inappropriate empirical therapy, contribute to increased bacterial resistance, and result in adverse events related to the treatment provided.