Incidental contrast opacification of the appendix secondary to urological intervention.

A 23-year-old otherwise well male, with right ureteric stent in situ placed electively for a 9-mm symptomatic pelviureteric junction stone underwent a right ureteropyeloscopy, retrograde pyelogram laser lithotripsy and stent exchange for stone clearance. The procedure was uncomplicated. Following stent removal on day 2, the patient developed acute right lower quadrant pain, which was investigated with non-contrast CT abdomen. The scan demonstrated a contrast-filled vermiform appendix, secondary to vicarious contrast excretion. This case report describes a rare manifestation of vicarious contrast excretion and explains this phenomenon.

COVID-19 did not delay time from referral to definitive management for head and neck cancer patients in a regional Victorian centre.

BACKGROUND: The COVID-19 pandemic has had widespread impacts on health services, particularly regarding the provision of urgent elective surgical services. It has influenced the evaluation of surgical patients, patient willingness to consult with medical services, and the ability to provide timely care to these patients. The aim of this study is to assess the impact of the COVID-19 pandemic on the time to definitive management for head and neck cancer in a regional setting. METHODS: A retrospective review was performed through the University Hospital Geelong Head and Neck Unit records and electronic medical records. Ethics approval for quality assurance was attained. The primary outcome was time from the first clinic appointment to commencement of definitive management. Statistical analysis was performed using Prism (version 8.0, GraphPad). RESULTS: A total of 127 patients were identified, 64 in the pre-COVID and 63 in the post-COVID period. In the post-COVID period, more patients (14.3%) had their first clinic appointment with telehealth compared to the pre-COVID period (1.6%). There was also no significant difference in time from referral to first clinic appointment or time from first clinic appointment to date of definitive treatment decision or multidisciplinary meeting. There was no significant difference in definitive treatment modality between groups. CONCLUSION: Despite increased adoption of telemedicine and increased public health considerations, there was no increase in time to definitive treatment from the time of referral to a regional head and neck cancer service.

Diagnostic concordance of telemedicine for otolaryngology, head and neck surgery in regional Australia.

BACKGROUND: The use of telehealth during the COVID-19 pandemic has emerged as both a necessary and significant tool in the provision of safe and timely healthcare in the field of otolaryngology. Increased access to specialist care in a regional setting is an additional benefit. Variation in diagnostic accuracy of telehealth consultations may affect diagnosis and management. Therefore, our aim is to determine the diagnostic concordance of telemedicine for otolaryngology in an Australian regional setting with physical consultations. METHODS: Retrospective review was conducted for all patients who received an initial telemedicine appointment over a 7-month period during the COVID-19 pandemic in regional Victoria, Australia. Data were collected regarding initial diagnosis and management from telemedicine consultations, subsequent physical appointment findings and management and intraoperative findings. Statistical analysis was performed using Prism (version 8.0, GraphPad). RESULTS: Two hundred and fifty-nine patients were included. The most common conditions referred were for consideration of tonsillectomy with or without adenoidectomy (44.0%). Overall diagnostic concordance of the initial referrer was 63.3% and for telephone appointments, it was 81.9%. Concordance of recommended treatment plans between telephone and physical appointments was 96.9%. CONCLUSION: Although physical appointments are an essential aspect of practice in OHNS, there are significant benefits of phone only telemedicine within the context of a global pandemic which were compounded by a regional setting. Paediatric patients were found to have the highest concordance of diagnosis and treatment plans.

3D-printed Titanium Prosthetic Reconstruction of the C2 Vertebra: Techniques and Outcomes of Three Consecutive Cases.

STUDY DESIGN: Three patients were treated at our center with patient-specific three-dimensional (3D)-printed titanium prostheses for the reconstruction of structurally compromised C2 vertebrae. OBJECTIVE: To describe our surgical and device design approach to these clinical scenarios and evaluate their outcomes. SUMMARY OF BACKGROUND DATA: There are a limited but increasing number of case reports and series describing the use of 3D-printed prostheses for high cervical surgery. METHODS: We have collated and reviewed three cases using patient-specific 3D-printed prostheses. RESULTS: We report two cases arising from neoplastic destruction; one resulting from metastatic medullary thyroid carcinoma, and the other from multiple myeloma. We additionally describe a case of C2 compromise as a complication of rheumatoid arthritis. All patients included in this report achieved successful surgical outcomes and symptom relief without significant complication. Clinical and radiological follow-up has demonstrated good outcomes in all cases up to 14-months postprocedure. CONCLUSIONS: These cases describe successful use of custom 3D-printed prostheses for reconstruction of the anterior vertebral column through C2, and add to the emerging body of literature detailing the use of custom prostheses for complex spinal surgery. LEVEL OF EVIDENCE: 4.