Extremely Late-Onset Deep Infection Post Inguinal Hernia Repair After Panendoscopy.

Mesh infection after hernia repair is a well-known complication, which can have morbid consequences. This report presents a case of a gentleman with mesh infection many years after initial surgery, potentially from bacterial translocation post-colonoscopy, and describes his successful treatment. This case emphasizes the need to consider mesh infection regardless of time from surgery to presentation.

Management of a nine litre abdominal wall seroma post ventral hernia repairs: A case report.

INTRODUCTION: seromas are a common and challenging complication post mesh hernia repairs (Morales-Conde, 2012; Salamone, 2015; Vasilakis, 2014). PRESENTATION OF CASE: A 52-year-old male was referred to General Surgery with a large abdominal mass in the setting of morbid obesity and multiple abdominal operations culminating in a ventral hernia repair seven years prior. He had no other abdominal symptoms or malignancy red flags. Imaging demonstrated a large, complex anterior abdominal wall seroma of 40 × 25 × 20 cm. No seromas of this size and location have been reported in the literature. DISCUSSION: Surgical management required drainage, partial capsulectomy and scarification of the remnants with multidisciplinary team involvement for recovery including general surgeons, anaesthesia, intensivists and allied health professionals. CONCLUSION: The patient recovered well from his operation.

Congenital band adhesion causing a proximal jejunal obstruction: an uncommon presentation and diagnosis.

A 20-year-old woman with no medical or surgical history presented with acute onset crampy abdominal pain on a background of uninvestigated similar chronic abdominal pain. She became obstructed during her admission and a contrast swallow showed a complete obstruction at the level of the proximal jejunum. A diagnostic laparoscopy revealed a congenital band adhesion from the greater omentum to the proximal jejunum to be the cause, and dissection of the band relieved her obstruction. This case presents a rare cause of mechanical obstruction, and highlights the seriousness of investigating obstructive symptoms even in atypical patient populations.

MMPI-2 restructured form over-reporting scales in first-episode psychosis.

MMPI-2-RF over-reporting scales for physical, cognitive, or psychological symptoms were examined in 130 consecutive referrals to a first-episode psychosis (FEP) clinic. Although acutely ill upon presentation, consistent and responsive profiles were obtained in 79% of the sample. There was no indication of under-reporting on defensive scales, and anticipated elevations were observed on clinical scales sensitive to thought disorder, ideas of persecution, and aberrant experiences. The Infrequent Somatic (Fs), Symptom Validity Scale (FBS-r), and Response Bias (RBS) scales did not indicate somatic or cognitive over-reporting, but the Infrequent Psychopathology Scale (Fp-r) showed a moderate elevation that may suggest a propensity for over-reporting or an effect of clinical symptoms on the over-reporting scale. Clinician ratings of positive symptoms of psychosis were related to the Fp-r. Although the over-reporting classifications with the RBS were relatively low, RBS scores were directly related to positive and general symptoms of psychosis. The MMPI-2-RF appears to have clinical value in an acutely ill FEP sample. The sample was not prone to over-reporting pathology, but associations between both the Fp-r and the RBS with clinical symptoms will warrant further investigation.

Traumatic retroperitoneal hematoma illustrated on Tc-99m methylene diphosphonate bone scintigraphy in a patient presenting with a fall.

Retroperitoneal haematoma is rarely described in the context of bone scintigraphy, as it is usually an incidental discovery on bone scan carried out for another purpose. We report a case of a right retroperitoneal haematoma detected on Tc-99m-methylene diphosphonate bone scintigraphy taken in an elderly patient presenting with a mechanical fall and a right acetabular fracture.

Social networks among users of mental health day care--predictors of social contacts and confiding relationships.

BACKGROUND: The social networks of people with mental illness have received much attention, but users of day care services have rarely been considered. METHODS: Users of day hospitals and day centres were surveyed cross-sectionally. Demographic and illness factors were tested for associations with network size, while intrinsic relationship factors were tested for association with confiding in a network member. RESULTS: There was some evidence that a longer duration of contact with services, more unmet needs, working, living in supported accommodation and needing help with psychotic symptoms were associated with having a larger network, while a longer duration of contact was associated with having more confidantes. Day centre users confided in people who were more likely to be friends or neighbours than professionals, and who were more likely to be the same sex. CONCLUSION: For people in day care, the stereotype that people with longer-term mental health problems are socially isolated is contradicted by this study. The limited role of professionals in providing confiding relationships is striking.

Social services day care and health services day care in mental health: do they differ?

BACKGROUND: The difference between the services provided by day hospitals and day centres is far from clear. The supposition that day hospitals would provide an acute service, while day centres would offer social support for a more chronic population has been contentious and there is little evidence of how they are currently used. AIMS: We aimed to ascertain the differences between day hospitals (partial hospitalisation) and social service day centres in functions and roles, as perceived by staff, service users and referrers. METHODS: The views of service users and staff at two day hospitals and four day centres were ascertained through questionnaires and interviews, along with those of staff of eight Community Mental Health Teams, who constitute the sole pathway to the two services. RESULTS: Day hospitals were perceived by both referrers and clients to offer short-term, more intensive 'treatment' to more acutely ill people in need of mental health monitoring. Day centres were perceived to offer longer-term support, particularly social support, to people more likely to have longer-term and psychotic illnesses. CONCLUSION: There is currently a clear distinction between day centres and day hospitals, in key features of their services and client groups. It would be unwise to treat them as interchangeable.

Social services and health services day care in mental health: the social networks and care needs of their users.

BACKGROUND: In view of the increasing integration of health and social care, there is an urgent need to know how health service day hospitals and social service day centres are being used, and by whom. AIMS: We aimed to compare users of day hospitals and centres in terms of their social networks, needs for care and demographics. METHODS: A cross-sectional, comparative study of service users at two day hospitals and four day centres compared their social networks, needs and characteristics. RESULTS: Day centre clients had much larger social networks, including a three-fold difference in total contacts and two-fold difference in confidants, but had more needs for care, particularly relating to psychological distress. They were also older on average than day hospital patients and were a more long-term group. CONCLUSION: It is vital to understand differences between health service day hospitals and social service day centres given the increasing integration of health and social care. The present study shows that the two user groups are significantly different. It is unlikely that the needs of most day care users could be met by either service interchangeably.

The impact of day hospital closure on social networks, clinical status, and service use: a naturalistic experiment.

OBJECTIVE: Little research is conducted on service closures. We examined the social, clinical and service use impact of the closure of a partial hospitalisation service (day hospital) on its users. METHODS: Patients attending the closing day hospital were studied at closure and one year after, and compared to patients at an unchanged day hospital. RESULTS: The closure did not increase use of inpatient beds, primary care or emergency room. Overall clinical improvements were similar for both groups as were costs. Social networks of the discharged patients decreased. CONCLUSIONS: Closures of services need to be as carefully evaluated as new developments.