A Three-year Retrospective Study Looking at Preventing Hospital Acquired Thrombosis.

Background: Hospital-acquired venous thromboembolism (HA-VTE) is defined as cases of venous thromboembolism (VTE) that occur in a hospital and within ninety days of a hospital admission. Deep vein thromboses (DVTs) most commonly occur within the deep veins of the pelvis and legs. If the thrombus dislodges and travels to the lungs, it can result in a pulmonary embolus (PE).

Do we need a co-pilot in the operating theatre? A cross-sectional study on surgeons' perceptions.

Objective: The aim of this original study was to investigate general surgeons' perceptions on the role of dual surgeon operating for high-risk, elective complex surgical procedures.

Material And Methods: A 21-part cross-sectional online survey was self-completed by 85 general surgeons across hospitals in the UK. The survey assessed the perception of dual surgeon operating on patient morbidity and mortality, surgeons' burnout rates, complaints, patient waiting times and overall trainee experience.

Cystic duct cyst in adults: a systematic review of the sixth entity.

Over the past two decades, there have been an increasing number of reports describing a sixth type of choledochal cyst (cystic duct cyst) in adults that was not included in Todani's classification. This sixth entity has not yet been systematically reviewed in the literature. We therefore explored this condition in adults from the perspective of the clinical presentation, diagnosis and treatment through a systematic review of the evidence.

Facing the unexpected: unusual causes of mechanical small bowel obstruction in adults.

Mechanical small bowel obstruction in adults is a common emergency condition that typically requires hospitalisation and usually acute surgical intervention. The majority of the cases are due to adhesive obstruction or common abdominal wall hernias or relevant related past history. However, the surgeons might face unexpected challenges in this concept due to rare causes of this condition.

Emphysematous cystitis: a cause of hematuria post angioplasty.

Emphysematous cystitis (EC) is a rare, severe, urinary tract infection caused by gas-producing bacteria. It is characterized by the accumulation of air inside the bladder wall and/or lumen and is common among elderly diabetic females. This case of a 90-year-old female, who underwent bilateral iliac angioplasty and stenting, is the first published correlation between iliac angioplasty and the development of EC.

Challenges encountered in the management of gall stones induced pancreatitis in pregnancy.

Background: Though uncommon, acute biliary pancreatitis in pregnancy carries a potential of serious and life threatening complications to mother and foetus. The management of acute pancreatitis in pregnancy is challenging due to the complexity of physiological and anatomical changes. This becomes even more challenging when invasive interventions are urgently needed.

Patient outcomes following carotid endarterectomy are not adversely affected by surgical trainees' operative involvement: A retrospective cohort study.

Background: Surgical training is an increasingly controversial topic. Concerns have been raised about both training opportunities becoming scarcer and poorer outcomes in operations led by surgical trainees; despite the evidence base for this being mixed. This retrospective cohort study aims to compare outcomes following carotid endarterectomy in patients who were operated on by a surgical trainee to those operated on by consultants.

Gene therapy for peripheral arterial disease.

Background: Peripheral arterial disease (PAD), caused by narrowing of the arteries in the limbs, is increasing in incidence and prevalence as our population is ageing and as diabetes is becoming more prevalent. PAD can cause pain in the limbs while walking, known as intermittent claudication, or can be more severe and cause pain while at rest, ulceration, and ultimately gangrene and limb loss. This more severe stage of PAD is known as 'critical limb ischaemia'.

Common femoral artery aneurysm repair using bifurcated graft.

Common femoral artery aneurysms are rare, and surgical repair is indicated if they are significantly large, or if they are symptomatic (thrombosis causing limb ischaemia and compression of surrounding structures). Synthetic grafts are preferred, especially in cases involving large aneurysms, or the bifurcation of the common femoral artery. We present a case of bilateral common femoral artery aneurysms extending into the bifurcation repaired using a synthetic graft which is traditionally used for an axillobifemoral bypass.

Management options in the treatment of femoral pseudoaneurysms secondary to intravenous drug abuse: A case series.

Introduction: Infected femoral pseudoaneurysms are a common presentation in intravenous drug users with little consensus as to the optimum management of these patients. Whilst emergency revascularisation options are available, excision and ligation of the femoral artery remains the most common operative intervention but risks leaving the patient with critical ischaemia or intermittent claudication. This case series reviewed the outcomes of 4 patients who underwent excision-ligation without revascularisation of an infected femoral pseudoaneurysm at a district general hospital.

Treatment of subclavian artery stenosis: A case series.

Introduction: In this case series, different modalities of treatment for patients with ischaemic symptoms of subclavian stenosis are described, including the different operative strategies that can be adopted in more challenging cases. This is the first case series describing these four management options.

Presentation: Case 1: A seventy-one year-old female presented with acute on chronic ischaemia of her left arm following a fall and developed dry gangrene of her left thumb.

Cell Therapy for Critical Limb Ischemia: A Meta-Analysis of Randomized Controlled Trials.

Early-phase trials showed the feasibility and potential efficacy of cell therapy in patients with critical limb ischemia (CLI). For systematic review, randomized controlled trials (RCTs) of cell therapy versus no cell therapy in CLI were searched from PubMed and the Cochrane library databases. Outcome measures included major amputation, complete ulcer healing, ankle-brachial index (ABI), and all-cause mortality.

Intra-abdominal removal of a displaced hip prosthesis.

Introduction: Intra-pelvic displacement of hip prostheses is an uncommon complication following arthroplasty surgery but can have significant detrimental effects on the patient. We present a case of a displaced hip prosthesis into the pelvic cavity and highlight the importance of pre-operative planning and investigation as well as choosing a suitable surgical approach.

Presentation Of Case: A 69 year old lady with developmental dysplasia of the hips was found to have displacement of her prosthesis into the pelvis on day three following complex uncemented total hip replacement.

Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices.

Background: Minimally invasive techniques to treat great saphenous varicose veins include ultrasound-guided foam sclerotherapy (UGFS), radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). Compared with flush saphenofemoral ligation with stripping, also referred to as open surgery or high ligation and stripping (HL/S), proposed benefits include fewer complications, quicker return to work, improved quality of life (QoL) scores, reduced need for general anaesthesia and equivalent recurrence rates. This is an update of a review first published in 2011.

Successful embolization of vulval varices arising from the external pudendal vein†.

Varicose veins in the vulvar and peri-vulvar area are seen in 4% of women and most commonly seen during pregnancy. It is thought to be as a direct result of the presence of ovarian and pelvic varicosities. Diagnostic modalities used in the investigation of this condition included pelvic ultrasound, computed venography, magnetic resonance venography and catheter-directed venography.

The WHO surgical safety checklist.

Surgery plays a prominent role in healthcare worldwide. It has been estimated that the rate of fatal events occurring in surgery is about one in ten thousand exposures and up to one million deaths per year. Most errors are caused by failure of non-technical skills.

Stump appendicitis: a review.

Acute appendicitis is perhaps the commonest cause of acute abdomen and surgical intervention in the form of open or laparoscopic appendicectomy. Stump appendicitis is an uncommon late complication of appendicectomy; where inflammation occurs in the remaining appendicular stump. Delayed diagnosis of this condition may result in serious complications.

Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices.

Background: Minimally invasive techniques to treat great saphenous varicose veins include ultrasound-guided foam sclerotherapy (USGFS), radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). Compared with conventional surgery (high ligation and stripping (HL/S)), proposed benefits include fewer complications, quicker return to work, improved quality of life (QoL) scores, reduced need for general anaesthesia and equivalent recurrence rates.

Objectives: To review available randomised controlled clinical trials (RCT) data comparing USGFS, RFA, EVLT to HL/S for the treatment of great saphenous varicose veins.

Carotid axillary bypass in a patient with blocked subclavian stents: a case report.

Introduction: Surgical treatment of symptomatic occlusive lesions of the proximal subclavian artery is infrequently necessary. Carotid subclavian bypass has gained popularity and is now considered standard treatment when stenting is not possible. Exposure of the subclavian artery and bypass grafting onto it is difficult, as the vessel is delicate, thin-walled and located deep in the supraclavicular fossa.

The start of a new era for stroke treatment: mechanical thrombectomy devices.

Stroke is a major cause of mortality in the U.K. accounting for 53,000 deaths every year.

An effective HIV vaccine: A combination of humoral and cellular immunity?

The development of a safe and effective HIV vaccine remains the best hope to control the global HIV epidemic. So far, the different strategies tried for vaccine development have led to disappointing results. The first attempted strategy involved trying to raise neutralizing antibodies to inactivate the virus and prevent infection.

Factors contributing to poor post-operative abdominal pain management in adult patients: a review.

Post-operative abdominal pain management can be a major issue facing medical and nursing staff in daily clinical practice. Effective pain control reduces post-operative morbidity as well as facilitates rehabilitation and accelerates recovery from surgery. In turn, poor pain control has been shown to alter body metabolic response that can lead to delayed recovery, with subsequent prolonged hospital stay and increased morbidity, and can lead to the development of a chronic pain state.

Old versus new anticoagulants: focus on pharmacology.

Heparin, low molecular weight heparin (LMWH) and warfarin are well-established anticoagulants still in widespread use despite their well known drawbacks. Heparin requires continuous monitoring, has serious side-effects such as haemorrhage, thrombosis and osteoporosis, and lacks an oral route of administration. LMWH is a safer, more convenient anticoagulant to use but it cannot be given orally, does not have an antidote and may be difficult to administer in patients with renal failure.

A Tender Pulsatile Epigastric Mass is NOT Always an Abdominal Aortic Aneurysm: A Case Report and Review of Literature.

Of greatest concern in the assessment of a patient with a tender pulsatile abdominal mass is the possibility of a leaking or ruptured Abdominal Aortic Aneurysm (AAA). Other serious abdominal pathologies may demonstrate the same clinical signs but require entirely different treatments. Even amongst patients with proven abdominal aortic aneurysms CT imaging findings may influence the timing and nature of surgery and provide useful prognostic information.