New-onset anosmia and ageusia in adult patients diagnosed with SARS-CoV-2 infection.

OBJECTIVES: We investigated the prevalence of anosmia and ageusia in adult patients with a laboratory-confirmed diagnosis of infection with severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2). METHODS: This was a retrospective observational analysis of patients infected with SARS-CoV-2 admitted to hospital or managed in the community and their household contacts across a London population during the period March 1st to April 1st, 2020. Symptomatology and duration were extracted from routinely collected clinical data and follow-up telephone consultations. Descriptive statistics were used. RESULTS: Of 386 patients, 141 (92 community patients, 49 discharged inpatients) were included for analysis; 77/141 (55%) reported anosmia and ageusia, nine reported only ageusia and three only anosmia. The median onset of anosmia in relation to onset of SARS-CoV-2 disease (COVID-19) symptoms (as defined by the Public Health England case definition) was 4 days (interquartile range (IQR) 5). Median duration of anosmia was 8 days (IQR 16). Median duration of COVID-19 symptoms in community patients was 10 days (IQR 8) versus 18 days (IQR 13.5) in admitted patients. As of April 1, 45 patients had ongoing COVID-19 symptoms and/or anosmia; 107/141 (76%) patients had household contacts, and of 185 non-tested household contacts 79 (43%) had COVID-19 symptoms with 46/79 (58%) reporting anosmia. Six household contacts had anosmia only. CONCLUSIONS: Over half of the positive patients reported anosmia and ageusia, suggesting that these should be added to the case definition and used to guide self-isolation protocols. This adaptation may be integral to case findings in the absence of population-level testing. Until we have successful population-level vaccination coverage, these steps remain critical in the current and future waves of this pandemic.

Endoscopic management of post-cholecystectomy bile leak.

Endoscopic management of post cholecystectomy biliary leak is described in a 56-year-old patient who developed a cystic duct leak following open cholecystectomy.

Endoscopic management of post-cholecystectomy bile leak

Endoscopic management of post cholecystectomy biliary leak is described in a 56-year-old patient who developed a cystic duct leak following open cholecystectomy

Perinephric abscess mimicking fulminant hepatic failure.

We describe a female diabetic patient who presented with features suggestive of hepatobiliary disease and who exhibited clinical signs of fulminant hepatic failure. Identification and drainage of a right perinephric abscess resulted in prompt resolution of both the physical signs and biochemical indices of liver disease. Infection remote from the hepatobiliary tree can mimic fulminant hepatic failure, and recognition of this unusual presentation of infection is important if dangerous delay in diagnosis and treatment is to be avoided.

Perinephric abscess mimicking fulminant hepatic failure

We describe a female diabetic patient who presented with features suggestive of hepatobiliary disease and who exhibited clinical signs of fulminant hepatic failure. Identification and drainage of a right perinephric abscess resulted in prompt resolution of both the physical signs and biochemical indices of liver disease. Infection remote from the hepatobiliary tree can mimic fulminant hepatic failure, and recognition of this unusual presentation of infection is important if dangerous delay in diagnosis and treatment is to avioded.

Rectus repair for midline ventral abdominal wall hernia.

Recurrence-free repair of midline ventral abdominal wall hernia continues to elude surgeons, despite the abundance of described techniques. Based on the observation that spontaneous herniation through the rectus abdominis muscles is unknown, a new technique of repair was devised. The rectus muscles and their sheaths on either side of the hernial defect are directly brought together to obliterate the hernia, the intervening linea alba and intact hernia sac being 'keeled' into the abdominal cavity. Using this technique, 85 consecutive midline abdominal hernias were repaired over an 11-year period. Follow-up was from 18 months to 12 years; there was one recurrence. The rectus repair is recommended as an effective method of dealing with ventral midline abdominal wall hernia.

Rectus repair for midlline ventral abdominal wall hernia

Recurrence-free repair of midline ventral abdominal wall hernia continues to elude surgeons, despite the abundance of described techniques. Based on the observation that spontaneous herniation through the rectus abdominis muscles is unknown, a new technique of repair was devised. The rectus muscles and their sheaths on either side of the hernial defect are directly brought together to blliterate the hernia, the intervening linea alba and intact hernia sac being 'keeled' into the abdominal cavity. Using this technique, 85 consecutive midline abdominal hernias were repaired over an 11-year period. Follow-up was from 18 months to 12 years; there was one recurrence. The rectus repair is recommended as an effective method of dealing with ventral midline abdominal wall hernia (AU)

Thyroid surgery without drainage: 15 years of clinical experience.

Drainage in thyroid surgery has been a routine but empirical practice with no scientific evidence to support its benefit. The largest series to date of non-drainage in thyroid surgery is presented, comprising 260 patients over a 15-year period. No case selection for non-drainage was employed. Two hundred and fifty-nine cases were not drained and included toxic goitres, and bilateral and redo procedures. There was one thyroid storm and two cases of subcutaneous fluid collection, treated by needle aspiration. No cases of recurrent laryngeal nerve injury, airway obstruction or death were recorded. This study strongly demonstrates the safety of non-drainage in routine thyroid surgery.

Thyroid surgery without drainage: 15 years of clinical experience

Drainage in thyroid surgery has been a routine but empirical practice with no scientific evidence to support its benefit. The largest series to date of non-drainage in thyroid surgery is presented, comprising 260 patients over a 15-year period. No case selection for non-drainage was employed. Two hundred and fifty-nine cases were not drained and included toxic goitres, and bilteral and redo procedures. There was one thyroid storm and two cases of subcutaneous fluid collection, treated by needle aspiration. No cases of recurrent laryngeal nerve injury, airway obstruction or death were recorded. This study strongly demonstrates the safety of non-drainage in routine thyroid surgery (AU)

A subcutaneous uterus with unusual presenting features.

A 32 year old female, para 2 + 0 presented with a hard lump in the scar of a lower midline incision. She had had a myomectomy 2 years previously and subsequently noticed the lump 3 months later. Her only complaints were urinary frequency during menstruation and the suprapubic mass. Surgery was performed for what was initially thought to be a desmoid tumour. At surgery the uterus was found to be lying in the subcutaneous position with no peritoneal sac. The uterus was dissected free of the sheath and reduced into the pelvis, uneventfully. This rare occurrence of a subcutaneous non-gravid uterus in the absence of a hernial sac is reported and its clinical features and possible preventative measures are discussed.

The impact of the ATLS course on traffic accident mortality in Trinidad and Tobago.

Advanced Trauma Life Support (ATLS) training of medical staff did not improve outcome of the trauma victim. Potential benefit of this course may have been masked by weak links in the trauma care chain such as pre-hospital care and in hospital investigative and therapeutic facilities.

Peripartum cardiomyopathy and arterial embolism.

A severely pre-eclampic patient developed peripartum cardiomyopathy and bilateral femoral emboli. Medical therapy for cardiac failure was commenced prior to delivery by Caesarean Section. Bilateral femoral embolectomy was performed on the sixth postpartum day.

The impact of the ATLS course on traffic accident mortality in Trinidad and Tobago

Advanced Trauma Life Support (ATLS) training of medical staff did not improve outcome of the trauma victim. Potential benefit of this course may have been masked by weak links in the trauma care chain such as pre-hospital care and in hospital investigative and therapeutic facilities.

Peripartum cardiomyopathy and arterial embolism

A severely pre-eclamptic patient developed peripartum cardiomyopathy and bilateral femmoral emboli. Medical therapy for cardiac failure was commenced prior to delivery by Caesarean Section. Bilateral femoral embolectomy was performed on the sixth postpartum day.

Primary repair of colon injuries in a developing country.

Because there are several specific disadvantages to a colostomy in a developing country, primary repair for colon injury was electively performed. Sixty-one consecutive patients with colon injury were seen between 1978 and 1989 and 57 of these (93 per cent) underwent primary repair. In four a colostomy was constructed. Emergency repair was carried out regardless of site or mode of injury, presence of hypotension or peritoneal contamination. There was one death unrelated to anastomotic complications and one anastomotic leakage. The faecal fistula closed spontaneously in 4 weeks. The wound infection rate was 10 per cent. These data support the emerging view that primary repair of colon injury is the management of choice.

Primary repair of colon injuries in a developing country

Because there are several specific disadvantages to a colostomy in a developing country, primary repair for colon injury was electively performed. Sixty-one consecutive patients with colon injury were seen between 1987 and 1989 and 57 of these (93 percent) underwent primary repair. In four a colostmy was constructed. Emergency repair was carried out regardless of site or mode of injury, presence of hypotension or peitoneal contamination. There was one death unrelated to anastomotic complications and one anastomotic leakage. The faecal fistula closed spontaneously in 4 weeks. The wound infection rate was 10 percent. These data support the emerging view that primary repair of colon injury is the management of choice (AU)

Obstructed left colon: one-stage surgery in a developing country.

Thirty-two consecutive cases of left-sided colonic obstruction are presented. Thirty cases were managed by primary resection and anastomosis without colostomy. No anastomotic leakage occurred. This procedure allowed significant conservation of material and personnel resources, with minimal patient morbidity.

Obstructed left colon: one stage surgery in a developing country

Thirty-two consecutive cases of left-sided colonic obstruction are presented. Thirty cases were managed by primary resection and anastomosis without colostmy. No anastomotic leakage occurred. This procedure allowed significant conservation of material and personnel resources with minimal patient morbidity (AU)