Renal cell carcinoma metastasis without a primary: A case report.

In Australia, approximately 3 % of all cancers diagnosed each year are renal cancers. Renal Cell Carcinoma (RCC) represents 90 % of all primary renal malignancies. RCC are slow growing and often asymptomatic, thus are often found incidentally. Here we present the case of a 76-year-old male who was found to have a metastatic RCC in a para-aortic lymph node with no primary lesion. He underwent a retroperitoneal lymphadenectomy and 15 months after the surgery, has had no signs of primary tumours or metastasis. This case reports on a rare instance of metastatic RCC without an identified primary renal malignancy.

Costs and challenges of the curriculum vitae for SET Urology training positions: a qualitative analysis.

BACKGROUND: Surgical training programs within Australia and Aotearoa New Zealand have become more competitive. Applicants are required to build a strong application over curriculum vitae (CV), references and interview. The building of the CV often comes at significant financial and time cost with challenges. This study explores successful applicants' experiences of the costs and challenges to build a successful CV for acceptance onto the Urology training program within Australia and New Zealand. METHODS: Qualitative content analysis (QCA) was undertaken of semi-structured interviews conducted with 11 nSET Urology trainees. QCA focused on the identification and evaluation of costs and challenges experienced. Analysis was reviewed over the domain of CV components. RESULTS: Costs of building each domain differed significantly between trainees as they focussed on various domains. Challenges encountered were identified with four themes were identified with associated subthemes: Passion/Commitment (two subthemes); Researching Pathways (six subthemes); Challenges (two subthemes) and Acceptance Success (two subthemes). CONCLUSIONS: The commitment to a surgical specialty begins before acceptance onto a training program. A high-level CV is an integral component of acceptance onto the Urology training program. Each trainee had a different journey, including time and financial sacrifices, to obtain acceptance whilst demonstrating a strong motivation for success. The average cost of each trainee who gained acceptance was $50 779 over 3 years. Consideration should be given to making the CV component less onerous.

Postoperative superior mesenteric artery syndrome following appendicectomy: A case report.

INTRODUCTION: Superior mesenteric artery syndrome is a rare cause of proximal intestinal obstruction. It is caused by a narrow aortomesenteric angle resulting in external compression of the duodenum as it traverses between the abdominal aorta and the superior mesenteric artery. Presenting symptoms tend to be non-specific and aetiological risk factors for this syndrome remain subjects to debate. The lack of awareness for this phenomenon often results in a delayed diagnosis, yet it can predispose to potentially life-threatening complications. CASE PRESENTATION: We describe an acquired case of SMA syndrome, in an 88-year old male who underwent an open appendicectomy 20 years prior. The patient presented with an 18-month history of progressive anorexia, weight loss, and intractable vomiting. After inconclusive initial investigations, an exploratory laparotomy demonstrated extensive postoperative adhesions, placing traction on the SMA through its ileocolic branch, resulting in acute angulation of the SMA and subsequent external duodenal compression. DISCUSSION: This case illustrates the acute evolving presentation of gastric and duodenal obstruction associated with SMA syndrome, and the need to raise the index of suspicion for its diagnosis. In this case, it is postulated that SMA syndrome presented as a late complication of an open appendicectomy - A rare presentation for a rare disease. CONCLUSION: SMA syndrome is an uncommon, but important differential for upper gastrointestinal obstruction. This case illustrates the challenges in the diagnosis of this rare clinical entity. Further study is warranted to understand the varied aetiology and optimal management for patients presenting with SMA syndrome.

Retro-ureteral Small Bowel Herniation After Radical Cystectomy.

Small bowel obstruction caused by internal herniation under ureteric bands is a rare occurrence. Only 6 previous cases have been documented. This case report reviews the case of a 79-year-old male who presented to emergency with abdominal pain requiring subsequent laparotomy and release of internal herniation of bowel under ureter.