Anticipating Urinary Retention Following Total Hip and Total Knee Replacements

@#Introduction: Urinary retention is a widely recognised postoperative complication. Although anecdotally lower limb arthroplasty is linked with high rates of urinary retention, there are no current accepted standards for determining which patients are at higher risk and should therefore be offered intra operative catheterisation. Materials and Methods: One hundred patients, 55 females and 45 males, who underwent uncomplicated total hip or total knee replacements at Furness General Hospital were recruited between January and April 2017. Results: Post-operative urinary retention was seen frequently, with 38 patients (38%) requiring post-operative catheterisation. Twenty-one males (46%) developed postoperative retention compared to 17 (30%) of females, representing a statistically significant increase in risk seen in male patients. (p 0.009). Post-operative urinary retention requiring catheterisation was associated with increasing age, with those over 75 years having a significantly higher risk than those less than 75 years irrespective of gender (p 0.04). There was no significant difference in urinary retention rates between patients who had general (n=21) or spinal anaesthetic (n=79) with 33% of GA patients and 39% of spinal anaesthetic patients requiring catheterisation (p 0.17). Conclusion: There are increased rates of urinary retention seen in lower limb arthroplasty patients than those described in the general surgical population, with male patients and all those over 75 years of age having a significantly higher risk. Clinically, it may therefore be sensible to consider offering routine intra operative catheterisation to this cohort of patients.

Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion / 부인종양

OBJECTIVE: Women with cervical cancer (CC) found to have positive surgical margins, positive lymph nodes, and/or parametrial invasion receive a survival benefit from postoperative chemoradiotherapy (CRT) vs. radiation therapy (RT) alone. However, older women may not benefit to the same extent, as they are at increased risk of death from non-oncologic causes as well as toxicities from oncologic treatments. This study sought to evaluate whether there was a survival benefit of CRT over RT in elderly patients with cervical cancer. METHODS: The National Cancer Database was queried for patients ≥70 years old with newly diagnosed IA2, IB, or IIA CC and positive margins, parametrial invasion, and/or positive nodes on surgical resection. Statistics included logistic regression, Kaplan-Meier overall survival (OS), and Cox proportional hazards modeling analyses. RESULTS: Altogether, 166 patients met inclusion criteria; 62 (37%) underwent postoperative RT and 104 (63%) underwent postoperative CRT. Younger patients and those living in areas of higher income were less likely to receive CRT, while parametrial invasion and nodal involvement were associated with an increased likelihood (p < 0.05 for all). There were no OS differences by treatment type. Subgroup analysis by number of risk factors, as well as each of the 3 risk factors separately, also did not reveal any OS differences between cohorts. CONCLUSION: In the largest such study to date, older women with postoperative risk factor(s) receiving RT alone experienced similar survival as those undergoing CRT. Although causation is not implied, careful patient selection is paramount to balance treatment-related toxicity risks with theoretical outcome benefits.

Survey of patients attending the eye clinic during the month of March; 1992

An audit survey was carried out during the month of March 1992 of patients attending the eye clinic. The number of patients; age and sex distribution; diagnosis; treatment modality and disposal were recorded. A total of 1166 patients were seen. The commonest diagnosis seen by the Ophthalmologist was non specific; and the commonest by the optometrist was presbyopia. Diseases required treatment included cataract; glaucoma and pterygium. Conditions that require screening included glaucoma and diabetic retinopathy. Prevention could be instituted in reducing other common conditions such trauma; pterygium and toxoplasma chorioretinitis

A seroepidemiological study of hepatitis B amongst Fiji health care workers.

Hepatitis B immunization for health care workers is common policy in many countries where they constitute a particular at risk group. A seroepidemiological study of hepatitis B virus (HBV) in Fiji health care workers was conducted to determine whether this occupational group (or subgroups thereof) were at higher risk of infection than the general Fiji population. The purpose of this study was to ascertain whether health staff should be immunized, or whether it would be more productive to focus resources on neonatal immunization. Blood samples were obtained from 2,639 health workers and the sera analysed by radio-immunoassay for hepatitis B surface antigen (HBsAg), and hepatitis B surface antibody (anti-HBs). Prevalence rates of HBV markers of infection were compared with those observed in the general population, from a previous population-based cluster sample survey. Approximately 70% of the health care staff participated in the study. Prevalence of total HBV markers was 24%. The rate of HBsAg was 5%. Sex and ethnic group specific prevalence rates varied. Male subjects, Fijians and "other" Pacific Islanders all experienced higher rates of infection. Rural/urban and age related trends were also observed. Rates of infection in health staff were lower than those reported in the general population. Previous studies have indicated that most of the transmission of hepatitis B in hyperemdemic Pacific populations occurs at birth or within the next few years. There was no consistent pattern of hepatitis B infection in different occupational groups of health care workers. Certain relatively socially homogeneous subgroups of health workers were analysed separately, and among these health workers there was evidence for increased risk of infection due to exposure to blood or used hypodermic syringes, but not due to patient contact. Until health staff assume a higher risk of infection than the general Fijian population, efforts directed at community-wide control of hepatitis B continue to be the most appropriate use of resources.

Safety and predictive value of exercise stress testing within three days after percutaneous transluminal coronary angioplasty.

The safety and efficacy of exercise stress testing within three days of successful coronary angioplasty was evaluated in 226 patients with coronary artery disease; 137 patients had single-vessel disease (SVD) and 89 had multi-vessel disease (MVD). Comparisons were made between patients with SVD and MVD and between patients whose vessels restenosed and those whose vessels remained patent. The post-angioplasty exercise test was positive in 48% of SVD and 49% of MVD patients. However, a positive result did not predict future restenosis. There was a significantly [p = 0.004] higher proportion of patients in the MVD group, compared with the SVD group, who exhibited greater than or equal to 2mm ST-depression, but again this was not indicative of restenosis. No complications as a direct result of having an early exercise test occurred. Exercise stress testing proved safe and was effective in demonstrating relief from angina in most patients early after coronary angioplasty. It did not, however, predict restenosis.