Adjustable versus non-adjustable male sling for post-prostatectomy urinary incontinence: A prospective clinical trial comparing patient choice, clinical outcomes and satisfaction rate with a minimum follow up of 24 months.

Aims: To review the patient choice, clinical outcomes and satisfaction rate between adjustable and non-adjustable male sling (MS) with a minimum follow up of 24 months.

Methods: A prospective review of clinical parameters in all male patients who underwent MS surgery between January 2009 and December 2011 was undertaken. Validated instruments were utilized in the follow-up survey.

Improving maternal and child health systems in Fiji through a perinatal mortality audit.

Objective: To develop a standardized process of perinatal mortality audit (PMA) and improve the capacity of health workers to identify and correct factors underlying preventable deaths in Fiji.

Methods: In a pilot study, clinicians and healthcare managers in obstetrics and pediatrics were trained to investigate stillbirths and neonatal deaths according to current guidelines. A pre-existing PMA datasheet was refined for use in Fiji and trialed in three divisional hospitals in 2011-12.

Chest pain on exertion after the Takeuchi repair of anomalous origin of the left coronary artery: right ventricular ischemia due to severe pulmonary outflow tract obstruction.

Right ventricular (RV) outflow obstruction (in the form of valvar or supravalvular pulmonary stenosis) is a well-known complication of the Takeuchi procedure. We describe a 13-year-old male with exertional chest pain, pulmonary stenosis, RV hypertrophy, and consequent RV ischemia, which was confirmed using stress echocardiography and single-photon emission tomography.

Sentinel Node Biopsy Alone versus Completion Axillary Node Dissection in Node Positive Breast Cancer: Systematic Review and Meta-Analysis.

Introduction. There has been recent interest in validity of completion axillary node dissection after a positive sentinel node. This systematic review aims to ascertain if sentinel lymph node dissection alone was noninferior to axillary lymph node dissection for breast cancer patients who have a positive sentinel node.

Hip resurfacing arthroplasty and perioperative blood testing.

It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty.

A descriptive study of nosocomial infections in an adult intensive care unit in fiji: 2011-12.

Nosocomial infections in an intensive care unit (ICU) are common and associated with a high mortality but there are no published data from the Oceania region. A retrospective study in Fiji's largest ICU (2011-12) reported that 114 of a total 663 adult ICU admissions had bacteriological culture-confirmed nosocomial infection. The commonest sites of infection were respiratory and bloodstream.

Intralesional bleomycin injection in management of low flow vascular malformations in children.

Low flow vascular malformations are challenging to manage, particularly with their propensity to grow, and can lead to severe disfigurement and dysfunction. Traditional surgical excision is fraught with tedious dissection and complications, particularly in the head and neck region. Trends toward less invasive techniques, such as intralesional sclerotherapy, are proving to be successful independent treatments or adjuncts in management in low flow vascular malformations.

Deep brain stimulation of the antero-medial globus pallidus interna for Tourette syndrome.

Background: We have previously reported the results of Deep Brain Stimulation (DBS) of the antero-medial globus pallidus interna (GPi) for severe Tourette Syndrome (TS) in 11 patients. We extend this case series to 17 patients and a longer follow-up to a maximum of 46 months.

Methods: 17 patients (14 male; mean age 29.

A state-of-the-art review on the evolution of urinary sphincter devices for the treatment of post-prostatectomy urinary incontinence: past, present and future innovations.

An artificial urinary sphincter (AUS) is the only mechanical device that closely simulates the function of a biological urinary sphincter. Over the past four decades, advances in mechanical design, applications of new technology and lessons learned from clinical experience have made AMS 800 device the standard of care in post-prostatectomy urinary incontinence. While the current AMS 800 device provides an effective, safe and durable option, it is not without its limitations and complications.

Ultrasound-assisted hip arthroscopy.

We describe the use of intraoperative ultrasound for the safe development of arthroscopic portals during hip arthroscopy without the requirement for fluoroscopy. We find this technique consistently accurate, allowing the safe introduction of arthroscopic instruments into the hip with a very low rate of iatrogenic injury. We have further developed the technique for application to both central- and peripheral-compartment procedures.

Prostate cancer survivorship: a review of erectile dysfunction and penile rehabilitation after prostate cancer therapy.

Prostate cancer diagnosis and treatment adversely affect quality of life for most men. The true incidence of erectile dysfunction (ED) after prostate cancer therapy is unknown, and the rates of ED in radical prostatectomy (RP) and radiation groups are similar, although the onset of ED is often later in patients treated with radiation therapy. Proposed pathophysiological mechanisms of ED include neurovascular injury, local inflammatory changes, damage to nearby supporting structures, cavernosal smooth muscle hypoxia with ensuing smooth muscle apoptosis and fibrosis, and corporal veno-occlusive dysfunction causing venous leakage.

Treatment for burn blisters: debride or leave intact?

This article presents findings from a systematic literature review of whether blisters arising from minor burns should be de-roofed or left intact. It discusses the risks of infection, healing outcomes, discomfort, choice of dressings and costs associated with each method, and reveals that debriding blisters larger than the patient's little fingernail while leaving smaller ones intact is generally agreed to be the best option. The article also explains external factors that influence the choice of whether to debride or leave blisters intact, reviews policy at the trust where one of the authors works in the context of the research and makes recommendations for practice.

Ultrasonography-assisted arthroscopic proximal iliotibial band release and trochanteric bursectomy.

We describe arthroscopic iliotibial band release and trochanteric bursectomy assisted by intraoperative ultrasonography for accurate placement of arthroscopic portals and to ensure adequate decompression of the peritrochanteric space. We have found ultrasonography for endoscopic iliotibial band release a useful tool to assist with localizing the site and length of decompression.

The use of a ureteric stone basket for removing loose bodies at hip arthroscopy.

We present the use of a ureteric stone basket for arthroscopic removal of loose bodies from the hip joint. The technique is easy to perform and reduces the time required for loose body retrieval while minimizing the risk of iatrogenic damage to the cartilage surfaces of the joint.

Diagnostic challenges in the evaluation of persistent or recurrent urinary incontinence after artificial urinary sphincter (AUS) implantation in patients after prostatectomy.

There is a lack of information pertaining to the postoperative evaluation in patients with artificial urinary sphincter (AUS) implants who complain and continue to have urinary incontinence (UI). Two types of UI can occur after the activation of an AUS device these are: early or initial (persistent) UI, and delayed (recurrent) UI. There are many causes of persistent and/or recurrent UI and these can sometimes overlap.

Diagnosis and management of a ruptured rudimentary horn pregnancy in a low-resource setting.

A 22-year-old woman presented with amenorrhoea, lower abdominal pain and brown vaginal discharge. She was noted to be in hypovolaemic shock with a distended and peritonitic abdomen. On bimanual examination, the uterus was not palpated, the posterior fornix was full and cervical excitation was present.

Golimumab may induce exacerbation of inflammatory bowel disease when it is used for the treatment of ankylosing spondylitis: a case report with a review of literature.

Golimumab is a human IgG monoclonal antibody specific for human tumor necrosis factor alpha. Golimumab has been approved for use in rheumatological conditions; however, its use in inflammatory bowel disease is still being evaluated in clinical trials. We report a case of an exacerbation of ulcerative proctitis after starting on golimumab for ankylosing spondylitis.

Risk modelling in quality clinical registries: monitoring lesion treatment failure rate in percutaneous coronary interventions.

Aims: This paper describes the development of a risk adjustment (RA) model predictive of individual lesion treatment failure in percutaneous coronary interventions (PCI) for use in a quality monitoring and improvement program.

Methods And Results: Prospectively collected data for 3972 consecutive revascularisation procedures (5601 lesions) performed between January 2003 and September 2011 were studied. Data on procedures to September 2009 (n=3100) were used to identify factors predictive of lesion treatment failure.

Use of graphical statistical process control tools to monitor and improve outcomes in cardiac surgery.

Background: Graphical Statistical Process Control (SPC) tools have been shown to promptly identify significant variations in clinical outcomes in a range of health care settings. We explored the application of these techniques to qualitatively inform the routine cardiac surgical morbidity and mortality (M&M) review process at a single site.

Methods: Baseline clinical and procedural data relating to 4774 consecutive cardiac surgical procedures, performed between the 1st January 2003 and the 30th April 2011, were retrospectively evaluated.

The Role of Weather in Meningitis Outbreaks in Navrongo, Ghana: A Generalized Additive Modeling Approach.

Bacterial (meningococcal) meningitis is a devastating infectious disease with outbreaks occurring annually during the dry season in locations within the 'Meningitis Belt', a region in sub-Saharan Africa stretching from Ethiopia to Senegal. Meningococcal meningitis occurs from December to May in the Sahel with large epidemics every 5-10 years and attack rates of up to 1000 infections per 100,000 people. High temperatures coupled with low humidity may favor the conversion of carriage to disease as the meningococcal bacteria in the nose and throat are better able to cross the mucosal membranes into the blood stream.

Evaluation of coronary angiographic projections to balance the clinical yield with the radiation risk.

Objective: Radiation safety principles dictate that imaging procedures should minimise the radiation risks involved, without compromising diagnostic performance. This study aims to define a core set of views that maximises clinical information yield for minimum radiation risk. Angiographers would supplement these views as clinically indicated.

A case report: simple and effective external fixator for finger fractures.

A case report on a very simple and very effective technique of achieving finger fracture fixation. This cost effective and yet simple tool and technique of immobilization is cheap and can be readily used in the South Pacific. This procedure provides us with an alternative to amputation of the digit.