ABSTRACT
INTRODUCTION: Skin necrosis is a rare complication of foam sclerotherapy, a common form of treatment for varicose veins. PRESENTATION OF CASE: Both patients presented to the outpatient clinic within 2-14days after foam sclerotherapy with Aethoxysklerol(®) 1%, with severe soft tissue and skin necrosis. Further aggressive treatment of the ulcer was required to resolve the necrosis, resulting in marked residual scar and well granulated leg ulcer respectively. DISCUSSION: Foam sclerotherapy is a common and usually well-tolerated treatment modality for varicose veins. The aetiology of skin necrosis is conventionally related to extravasation of sclerosant. In order to minimise the risk of necrosis, the lowest concentration and lowest volume of sclerosant necessary to achieve adequate treatment of the target vein should be used. CONCLUSION: We would like to emphasise that whilst skin and soft tissue necrosis is a rare complication of foam sclerotherapy, it is a complication that is highly disfiguring and requires aggressive treatment. As such, it should be adequately discussed with the patient prior to obtaining informed consent.
ABSTRACT
We report the case of a large superior gluteal artery aneurysm treated with covered stent-graft insertion. Exclusion of the aneurysm was achieved, with resolution of symptoms and shrinkage of the sac, without the need for embolization.
Subject(s)
Aneurysm/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Buttocks/blood supply , Endovascular Procedures/instrumentation , Stents , Aged , Aneurysm/diagnostic imaging , Aneurysm/physiopathology , Computed Tomography Angiography , Humans , Male , Remission Induction , Treatment OutcomeABSTRACT
OBJECTIVE: To improve the quality and efficiency of our emergency surgical service. METHODS: Until 2007, the surgical on-call in our unit was run on a 'consultant of the day' model with triage in a 10-bed surgical receiving unit (SRU) before admission to the wards. The reduction in junior doctors' hours meant little continuity and delays in care.In July 2007, the SRU was expanded and a daily on-ward ultrasound session was established. The consultant rota was changed to a split-week model with twice-daily SRU ward rounds, allowing unstable patients regular senior assessment. RESULTS: As a result of the change, our acute length of stay reduced from 4.4 to 3.8 days and our actual versus expected length of stay was the best figure country-wide. CONCLUSION: Early consultant review and swift ultrasound assessment reduce admissions and patient stay. We have combined these factors in our emergency service and have delivered significant cost savings and improved care.
Subject(s)
Critical Care/statistics & numerical data , Efficiency, Organizational/statistics & numerical data , Emergency Treatment/statistics & numerical data , Quality of Health Care/statistics & numerical data , Triage/statistics & numerical data , Diffusion of Innovation , Emergency Treatment/standards , Humans , Length of Stay/statistics & numerical data , Models, Organizational , Patient Admission/standards , Patient Admission/statistics & numerical data , Quality of Health Care/standards , Radiology Department, Hospital/standards , Radiology Department, Hospital/statistics & numerical data , Triage/methods , Triage/standards , Ultrasonography , United KingdomABSTRACT
We report a 14-year-old girl who presented with epigastric pain, vomiting, and an upper abdominal mass. A diagnosis of trichobezoar was made on ultrasound and she went on to have a laparotomy, where a large trichobezoar was extracted with a tail that extended into the small intestine.
Subject(s)
Bezoars/diagnostic imaging , Duodenum , Pica/diagnosis , Stomach , Adolescent , Bezoars/psychology , Bezoars/surgery , Female , Follow-Up Studies , Humans , Laparotomy/methods , Pica/psychology , Risk Assessment , Syndrome , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Colorectal cancer is the second most common cause of death from cancer in the UK. It is estimated that between 2 to 3 per cent of colorectal cancer occurs in patients younger than the age of 40 years. It remains unclear from the literature whether this group of patients has a worse prognosis from colorectal cancer than the population as a whole. There are no large series that report a 10-year survival in young patients diagnosed with colorectal cancer. The authors' objective was to assess patients diagnosed with colorectal cancer younger than the age of 40 years to determine whether the 5- and 10-year survival rates in a tertiary referral center compares favorably with survival rates obtained at other centers and the population as a whole. A retrospective observational study was conducted and an analysis of the patient's notes was made, specifically looking at age at diagnosis, nature and duration of symptoms, predisposing risk factors for colorectal cancer, the site within the bowel of the colorectal cancer, the type of curative resection performed, Dukes' stage, and details of 5- and 10-year follow-up to assess survival. Forty-nine patients age 40 years or younger received treatment for colorectal cancer at St. Mark's Hospital from 1982 to 1992. The overall 5- and 10-year survival was 58 per cent and 46 per cent respectively. The study provides more evidence to support the fact that young patients with colorectal cancer seem to present with more advanced disease. Despite this, the overall 5-year relative survival rate is comparable if not better than other studies, supporting recent evidence that the prognosis in this group of patients is no worse than for colorectal cancer in the population as a whole.
