A diagnostic dilemma: a case report of concomitant duodenal Dieulafoy lesion and gastric ulcer.

Dieulafoy lesions (DL) are an uncommon cause of gastrointestinal bleeding which is often difficult to diagnose due to the rarity of the condition and varying clinical presentations. This case describes an unusual presentation of upper gastrointestinal bleeding in an 85-year-old female with findings on two separate gastroscopies of both a gastric ulcer and duodenal DL. The pathophysiology of DL remains poorly understood and despite shared risk factors, these two pathologies are rarely reported concurrently.

Pneumomediastinum and pneumothorax: a rare complication of laparoscopic total extraperitoneal inguinal hernia repair.

Increasing utilization of a laparoscopic total extraperitoneal (TEP) approach for inguinal hernia repairs has led to rare complications. We describe a rare case of subcutaneous emphysema, pneumomediastinum and pneumothorax following a laparoscopic TEP inguinal hernia repair in a 29-year-old male. Mechanisms posited include extraperitoneal carbon dioxide migration via the retroperitoneal space and dissection along the fascia transversalis and endothoracic fascia anteriorly to enter the mediastinum.

A delayed benign anastomotic stricture after anterior resection for sigmoid adenocarcinoma with concomitant collagenous colitis.

Benign anastomotic strictures most commonly occur within 3-12 months after anterior resection (AR) with chronic symptoms amenable to endoscopic treatment. This case describes an acute large bowel obstruction secondary to a severe delayed benign anastomotic stricture in a 74-year-old female who had previously underwent a laparoscopic AR for sigmoid adenocarcinoma 3 years prior. The pathophysiology of benign anastomotic strictures remains poorly understood.

A rare case of oesophageal and gastric fundus necrosis following traumatic splenectomy.

Oesophageal and gastric fundus necrosis are rare clinical entities and have not previously been reported concurrently. This case study describes oesophageal and gastric fundus necrosis in a 71-year-old female who developed chest pain post-splenectomy for infected splenic haematoma in the context of a fall. Upper gastrointestinal endoscopy demonstrated oesophageal and gastric fundus necrosis.

Primary abdominal Tyre blast injury: A rare case of intra-abdominal trauma.

Tyre blast injuries are an infrequently encountered but important cause of significant injury. Due to their rare nature tyre blast injuries are often not recognised as major trauma and this can pose significant risk to patient.

Operative experience of general surgeons in a rural hospital.

Background: There is a lack of published data on the range of procedures currently carried out by rural general surgeons. The aim of this study is to demonstrate the diversity of conditions encountered and managed by rural general surgeons, in order to determine the scope of training necessary to adequately equip trainees for rural practice.

Methods: An audit of surgical procedures completed by two surgeons over 5 years from June 2004 to June 2009 in a rural Victorian hospital was carried out.

An unusual case of bilateral verrucous carcinoma of the foot (epithelioma cuniculatum).

Verrucous carcinoma is a rare, well-differentiated variant of squamous cell carcinoma with a minimal incidence of metastasis. Conservative treatment and local excision have been utilized although with high recurrence rates. We present a unique case of a 44-year-old male with bilateral foot involvement with recurrences after local excision, leading to management with bilateral forefoot amputations.

Infrarenal aortic aneurysm surgery in a rural surgical service: risk factors for mortality.

Background: An audit of both the emergency and elective abdominal aortic surgery that was performed in a rural surgical service, was carried out.

Methods: Retrospective data analysis was performed on 41 patients who were treated for abdominal aortic aneurysms (AAA) during an 8-year period from 1989 to 1996. Postoperative outcomes were analysed with respect to patient age, mode of presentation (elective or emergency), transfusion requirements and pre-existing cardiac and respiratory disease.

Meta-analysis and investigation of anti-infective therapies.

Meta-analysis offers an alternative approach to examining specific sub-groups, such as classes of antibiotics, types of bacteria as well as patient groups whose response to the agent under investigation may not be equivalent. In this review, the strengths and pitfalls of meta-analyses of anti-infective therapies will be discussed.

Limited adverse occurrence screening: using medical record review to reduce hospital adverse patient events.

Objectives: To determine whether continuous detection of adverse patient occurrences followed by analysis and medical intervention can alter the rate of adverse occurrences.

Design And Participants: 15912 patients discharged from one hospital were reviewed in two stages. Medical records were screened retrospectively by medical records staff for one or more of eight general patient outcome criteria.

Auger injuries in the Wimmera region 1987-95.

Background: Eighteen cases of auger injuries in the Wimmera region of Victoria were treated over 8 years.

Methods: The records of auger related injuries presenting to Wimmera Base Hospital from March 1987 to March 1995 were reviewed.

Results: Five of these were severe injuries.

Limited adverse occurrence screening: an effective and efficient method of medical quality control.

The objective of the present study was to determine the rate of adverse patient occurrences in a medium sized hospital and to assess the effectiveness and efficiency of limited adverse occurrence screening as a method of medical quality control. The medical records of inpatients discharged from a base hospital in Horsham, Victoria, were screened by the medical records department using eight general outcome criteria. Histories found to meet a criterion were sent to a medical reviewer to determine if an adverse patient occurrence had taken place.

Myocardial infarction in a rural hospital.

Little is known of the outcome of myocardial infarction in patients managed in regional hospitals, where investigational and therapeutic modalities may have limited availability. Policies in place in the Intensive Care Unit of Wimmera Base Hospital for the management of myocardial infarction are designed to ensure that current 'best practice' is followed where possible. In order to audit our practices, and to ensure that these practices lead to patient outcomes similar to those published in cardiological literature, we performed a case note audit of patients admitted with myocardial infarction.

A review of methods used for medical quality assurance in hospitals: advantages and disadvantages.

This paper reviews the advantages and disadvantages of medical quality assurance methods commonly used in hospitals. A computer-based literature search up to April 1993 was done using the terms quality assurance, quality control, audit, utilization review, accreditation, occurrence screening and total quality management. In addition, a manual search was undertaken of references of papers obtained by the computer search and of the contents of the following journals: Quality Review Bulletin, Australian Clinical Review and the British Medical Journal.

Preparation for hospital accreditation: an efficient and practical approach.

Hospital accreditation has been criticized for its emphasis on structure and documentation. Less attention is given to the clinical process and outcomes of care. How can the accreditation process become a meaningful part of day-to-day hospital management? Four approaches are discussed.

Psoas abscess following ingestion of psoas.

A case of right psoas abscess that was caused by duodenal perforation following the ingestion of a wooden skewer from a filet mignon is presented. Surgical repair of the perforation, drainage of the abscess and 5 days of intravenous antibiotics resulted in prompt recovery.

Limited adverse occurrence screening. A medical quality control system for medium sized hospitals.

Objective: To determine whether adverse occurrence screening of inpatient discharge summaries by means of a limited number of criteria can provide an effective medical quality control system without requiring substantial additional resources.

Design: The medical records department used 14 criteria to screen all inpatient discharge summaries shortly after discharge. Summaries that met particular criteria were sent for medical review.

Family-planning clinics and educational programmes--a rural experience.

Although family-planning clinics are numerous and well-accepted in most Australian capital cities, such clinics have been difficult to establish in some Victorian rural towns. One such clinic was established at a rural base hospital in a Victorian town in 1984. The history of the clinic's development and its mode of operation are discussed.