Case report of successful partial splenectomy for a splenic abscess in a paediatric patient.

Introduction: Splenic abscess (SA) is a rare potentially fatal condition in the paediatric population. It is difficult to diagnose given its non-specific presentation. There are no current guidelines for management of SA in this population but splenic preservation is advantageous given the vital role the spleen plays in immunity.

Human fetal dendritic cells promote prenatal T-cell immune suppression through arginase-2.

During gestation the developing human fetus is exposed to a diverse range of potentially immune-stimulatory molecules including semi-allogeneic antigens from maternal cells, substances from ingested amniotic fluid, food antigens, and microbes. Yet the capacity of the fetal immune system, including antigen-presenting cells, to detect and respond to such stimuli remains unclear. In particular, dendritic cells, which are crucial for effective immunity and tolerance, remain poorly characterized in the developing fetus.

There Is No Role for Colonoscopy after Diverticulitis among Asian Patients Less than 50 Years of Age.

Background: Colonoscopy is advocated following acute diverticulitis to ensure that malignancy is not missed. In an Asian population, diverticulitis is more common in the right colon and in younger patients. The purpose of this study is to examine the utility of colonoscopy amongst Asian patients <50 years of age who have had colonic diverticulitis.

Young colorectal cancer patients often present too late.

Purpose: Current screening and health education strategies on colorectal cancer (CRC) remain focused on individuals >50 years old. However, CRC in young adults is not uncommon. This paper aims to explore how CRC presents in young adults and their clinical outcomes.

Pen Torch Transillumination: Difficult Venepuncture Made Easy.

Introduction: Our novel technique of pen torch transillumination (PTI) uses a cheap and easily available instrument (Penlite-LP212, Energizer, Missouri, USA) to visualize superficial veins invisible to the naked eye. We evaluate the efficacy of PTI in improving venepuncture success rate (SR) for patients with poor venous access.

Methods: This prospective randomized controlled trial looked at adult patients (n = 69) aged 21-90 with difficult venous access (history of ≥3 consecutive attempts required for successful cannulation during the current admission) requiring non-emergent venepuncture.

Getting the first degree relatives to screen for colorectal cancer is harder than it seems-patients' and their first degree relatives' perspectives.

Introduction: First degree relatives (FDR) of colorectal cancer (CRC) patients are at increased risk of CRC compared to the general population. However, screening colonoscopy rates amongst the FDRs remain dismal. The aim of the study was to explore the various issues amongst the patients and their FDR precluding their adoption of screening colonoscopy.

Biliary metastasis in colorectal cancer confers a poor prognosis: case study of 5 consecutive patients.

The biliary duct is an extremely rare site for colon cancer metastasis. It often leads to a diagnostic dilemma, since primary cholangiocarcinoma (potentially treatable with surgery) has a similar presentation. This paper highlights our experience with 5 consecutive patients who had colon malignancy with biliary metastasis, and prognosis of their disease.

Totally extra-peritoneal repair for acute incarcerated femoral hernia with intestinal obstruction.

Introduction: Femoral hernias frequently present with incarceration, resulting in obstruction and strangulation. Laparoscopic groin hernia repairs have been shown in the elective setting to be an effective alternative to open repair. Acute incarceration of groin hernia with obstruction, though previously seen as a relative contraindication, has been increasingly repaired with minimally invasive techniques, with the potential benefit of avoiding the morbidity associated with a laparotomy.

Extent of field change in colorectal cancers with BRAF mutation.

Introduction: Sporadic colorectal cancers with BRAF mutations constitute two distinct subgroups of colorectal cancers. Recent studies have linked the presence of the BRAF mutation to a familial inheritance pattern. This was a proof-of-concept study that aimed to examine: (a) the extent of field change in sporadic colorectal cancers with BRAF mutation; and (b) the extent of resection margins required and the pattern of DNA mismatch repair protein loss in these tumours.

Extensive peritoneal lavage after curative gastrectomy for gastric cancer (EXPEL): study protocol of an international multicentre randomised controlled trial.

Peritoneal recurrence after gastrectomy for gastric cancer is common and the prognosis is dismal. Recent evidence suggests that extensive peritoneal lavage with large volume of normal saline after surgery before abdominal closure can reduce the risk of peritoneal recurrence and improve overall survival. This study aims to evaluate the benefit of extensive intraoperative peritoneal lavage.

Are hemoglobin levels really lower in faecal immunochemical test positive patients with colorectal cancer?

Introduction: Faecal immunochemical test (FIT) is advocated in many colorectal cancer-screening programs. A positive FIT translates to the need for a colonoscopy. However, waiting times for diagnostic colonoscopy is long.

Endoscopic Stenting Does Not Worsen Long Term Outcomes Amongst Patients Presenting with Obstruction from Colorectal Cancers.

Background: Stenting has been increasingly adopted in colorectal cancer patients presenting with acute large bowel obstruction. However, long-term outcomes of stenting are lacking in the literature. Our study attempts to compare the long-term outcomes of colonic stenting and emergency surgery amongst left-sided colorectal cancer patients presenting with acute large bowel obstruction.

Thinking out of the : a case of obscure lower GI bleeding.

Clinical Presentation: A middle-aged man was admitted for episodes of fresh per-rectal bleeding, which were not associated with defecation. He was recently investigated for macrocytic anaemia in the outpatient haematology clinic. Examination of the perineum revealed grade 1 internal haemorrhoids with no signs of bleeding.

Attitudes and Concerns of Diabetic Patients towards Bariatric Surgery as Treatment of Diabetes.

Introduction: Bariatric surgery is increasingly recognised as an effective treatment for type 2 diabetes that significantly improves glycaemic control, even achieving remission. This study examined perceptions and concerns of diabetic patients towards bariatric surgery as a treatment option for diabetes.

Materials And Methods: A total of 150 patients were recruited from a specialised diabetic outpatient clinic and completed a questionnaire (items were rated on a Likert scale from slightly important [lowest score of 1] to extremely important [maximum score of 5]).

Comprehensive Comparison of the Performance of Autogenous Brachial-Basilic Transposition Arteriovenous Fistula and Prosthetic Forearm Loop Arteriovenous Graft in a Multiethnic Asian Hemodialysis Population.

For patients who have exhausted cephalic vein arteriovenous fistula (AVF) options, controversy exists on whether brachial-basilic AVF with transposition (BBTAVF) or a forearm arteriovenous graft (AVG) should be the next vascular access of choice. This study compared the outcomes of these two modalities. A retrospective study of 122 Asian multiethnic patients who underwent either a BBTAVF (81) or an AVG (41).

Laparoscopic surgery should be considered in T4 colon cancer.

Introduction: Laparoscopy in T4 colon cancers is not widely advocated due to concerns regarding safety and oncologic efficacy. We conducted this study to compare the short- and long-term oncological outcomes between laparoscopic and open approaches in T4 colon cancers.

Methods: A retrospective analysis of all patients who underwent surgery for T4 colon cancer from 2008 to 2014 was performed.

Unilateral Pelvic Side-Wall Lymph Node Resection for Rectal Cancer: A Review of the Anatomy.

Background: The aim of this video is to highlight key safety and critical techniques employed during laparoscopic pelvic side-wall lymph node resection for rectal cancer. In addition, a review of the key pelvic side-wall anatomical structures will be included.

Methods: We report a case of a 50-year-old Chinese female who presented with per-rectal bleeding, with colonoscopy revealing a 1.

Tips and tricks to avoid bile duct injury in SILC: an experience of 500 cases.

Introduction: Conventional laparoscopic cholecystectomy is the gold standard surgical treatment for symptomatic gallstones. Surgeons have attempted to minimize the number of incisions via single-incision laparoscopic cholecystectomy (SILC), which offers benefits including improved cosmesis, possibly less postoperative pain, and improved patient satisfaction. However, studies show that there is an increased risk of operative complications-in particular bile duct injuries.