ABSTRACT
Key Clinical Message: Colorectal cancer is the third most common malignancy worldwide, with an increasing incidence. Colonic metastasis is a rare occurrence; thus, misdiagnosis is common. Immunohistochemistry facilitates accurate diagnosis and subsequent management. Abstract: Most cancers in the colon are primary colorectal cancers, however metastasis from another primary is possible, albeit rare. Endometrial cancer metastasis to the colon is a rare occurrence and is only described in a handful of cases. We describe a rare case of metastatic endometrial cancer in the colon presenting 5 years post radical hysterectomy and adjuvant radiotherapy in a 62-year-old female. She presented with a 1-week history of right upper quadrant pain, with no other associated symptoms. She was presumed to have a primary colorectal cancer based on her colonoscopy and CT findings; later proven otherwise by immunohistochemistry (IHC). Endometrial cancer metastasis to the colon is rare, thus misdiagnosis can easily occur. Currently, there are 6 similar cases reported in the literature, all occurring in the absence of colorectal endometriosis. This case illustrates the relative importance of considering colon as a potential site for metastasis of endometrial cancer and the utility of IHC in aiding diagnosis and guiding further management.
ABSTRACT
BACKGROUND: Moyamoya vasculopathy is a rare steno-occlusive cerebrovascular disorder presenting with ischemia or hemorrhage. There are racial and geographic differences in presentation and outcome. There is little information regarding moyamoya in Australia. METHODS: Moyamoya patients undergoing surgery from 2001 to 2022 were studied retrospectively. The outcomes of revascularization surgery in adult and pediatric patients, with ischemic and hemorrhagic disease were analyzed, including functional outcomes, postoperative complications, bypass patency, and long-term rates of ischemic and hemorrhagic events. RESULTS: A total of 68 patients with 122 revascularized hemispheres and 8 posterior circulation revascularizations were included in this study. Eighteen patients were of Asian descent and 46 were of Caucasian origin. Presentation was with ischemia in 124 hemispheres and hemorrhage in six hemispheres. There were 92 direct, 34 indirect, and 4 combined revascularization surgeries performed. Early postoperative complications occurred in 3.1% (n = 4) of operations and delayed complications (infection, subdural hematoma) occurred after 4.6% (n = 6) of operations. Mean follow-up was 6.5 years (3-252 months). There was 100% patency of direct grafts at last follow-up. There were no hemorrhagic events following surgery and 1 new ischemic event 2 years after surgery. There was significant improvement in physical health functional outcomes at most recent follow-up (P < 0.05); mental health outcomes were not different between preoperative and postoperative assessments. CONCLUSIONS: The majority of Australian moyamoya patients are Caucasian and the most common clinical presentation is ischemia. Revascularization surgery had excellent outcomes with very low rates of ischemia and hemorrhage, comparing favorably to the natural history of moyamoya vasculopathy.
ABSTRACT
OBJECTIVES: Australia is lagging behind other countries in implementing quality indicators (QIs) in home- and community-based aged care. This research aimed to identify and appraise home care QI sets used internationally for older adults, to inform the future development and utilisation of QIs in the Australian context. METHODS: A systematic search of eligible studies outlining the development and validation of home care QI sets for older adults was undertaken. QIs were categorised using the Donabedian model to identify potential gaps in coverage of key areas of care quality. Each QI was classified as potentially "derivable" or not from existing national routinely collected datasets. Methodological quality was determined using the Appraisal of Indicators through Research and Evaluation instrument. RESULTS: Three sets of home care QIs developed and used internationally for older adults were identified. Two of the QI sets focused predominantly on clinical and functional aspects of care. Of 45 unique QIs, the majority were outcome measures (93%), with only three QIs measuring care processes (7%), and zero indicators measuring quality in terms of the structure of care (e.g., waiting time to access services). Nearly half of the individual indicators identified would require Australian home care providers to undertake additional data collection. There were significant methodological limitations in the development of QI sets, particularly in the scientific evidence domain. CONCLUSIONS: This review identified important gaps in existing QI sets, which should be considered by policymakers, researchers, and other stakeholders when developing and applying QIs in the Australian setting.
