A staged hybrid approach to an aberrant right subclavian artery with symptomatic Kommerell's diverticulum.

Aberrant right subclavian is a rare anomaly presenting in 0.3-3.0% of the population. Kommerell's diverticulum is an aneurysm associated with this phenomen; data relating to its incidence is sparse. Currently there are no well-established guidelines for the treatment of Kommerell's diverticulum, limitation being the rare occurrence of disease and heterogenous population with disease presentation. This case report illustrates a novel approach to the repair of a symptomatic Kommerrel's diverticulum with severe coronary disease. Management should be tailored on a case by case basis to the individual patient.

First-in-man experience of self-expanding nitinol stents combined with drug-coated balloon in the treatment of femoropopliteal occlusive disease.

Purpose The present study aimed to determine the safety and efficacy of a drug-coated balloon inflated within a thin-strut self-expanding bare-metal stent in patients with severe and complex femoropopliteal occlusive disease. Methods This prospective study used the Pulsar-self-expanding stent and Passeo-18 Lux drug-coated balloon in patients with severe and complex femoropopliteal occlusive disease. The primary endpoint was the 12-month primary patency, and the secondary endpoints included 24-month primary patency, assisted primary patency, secondary patency, and clinically associated target lesion revascularisation. Results The study included 44 patients (51 limbs). The mean age of the patients was 67.6 ± 10.2 years, with 73% men. Chronic limb severity was classified as Rutherford Category III in 41% of the patients, stage IV in 31%, and stage V in 27%. Lesions were predominantly Trans-Atlantic Inter-Society Consensus (TASC 2007) D (51%) and C (45%), with 32 (63%) chronic total occlusions. Procedural success was obtained in all cases. The mean lesion length was 200 ± 74.55 mm (95% CI = 167.09-208.01) with a mean number of stents per limb used of 1.57 ± 0.70 (95% CI = 1.37-1.76). Distal embolisation occurred in two patients. The primary patency rates at the 12- and 24-month follow-up were 94% (95% CI = 82.9-98.1) and 88% (95% CI = 75.7-94.5), respectively. The assisted primary was 94% (95% CI = 82.9-98.1) and secondary patency was 96% (95% CI = 85.2-99.0) at 24-month follow-up. The cumulative stent fracture rate at the 24-month follow-up was 10%. Freedom from clinically driven target lesion revascularisation was 94% (95% CI = 83-98%) at 12-month follow-up and 88% (95% CI = 76-94%) at 24-month follow-up, with two patients requiring a bypass graft. Conclusion Our novel approach involving the combination of a thin-strut bare-metal stent and a drug-coated balloon may be safe and effective, with sustainable and promising clinical outcomes up to 24 months after treatment.

Predictive factors for publication of abstracts at the Royal Australasian College of Surgeons Annual Scientific Congress.

BACKGROUND: A key metric of the research quality of medical conferences is the publication rate of abstracts. The study objective was to determine the publication rate of abstracts presented at the Royal Australasian College of Surgeons Annual Scientific Congress (RACS ASC) and to examine for any predictive factors associated with publication. METHODS: Abstracts presented at the RACS ASC from 2011 to 2013 were analysed. Abstract characteristics such as presentation format, study type, study design, study site, cohort size and author origin were recorded. Abstracts published were identified by a PubMed search using a strict algorithm. Univariate and multivariable logistic regressions were used to analyse for predictive factors of publication. RESULTS: Overall, 1438 abstracts were presented and 423 abstracts (29%) were published. The median time to publication was 15.2 months (interquartile range: 8-26) with 110 in Australasian journals (26%). The median number of citations for published abstracts was 6 (interquartile range: 2-16). After multivariable analysis, publication was significantly associated with prospective study design (odds ratio (OR) = 1.34, P = 0.02), multicentre study site (OR = 1.43, P = 0.02), cohort size ≥100 (OR = 2.00, P < 0.001) and New Zealand author origin (OR = 1.50, P = 0.01). CONCLUSION: Our study demonstrates that less than one-third of abstracts presented at the RACS ASC are subsequently published in a peer-reviewed journal. Factors significantly associated with journal publication include prospective studies, multicentre study, a larger cohort size and New Zealand author origin. Advances in surgery may progress from the preliminary findings of conference abstracts. However only after the rigorous peer review offered by journal publication should changes in decision-making of patient care occur.

Anaemia in school-aged children in an Australian Indigenous community.

OBJECTIVE: Indigenous Australians have poorer health outcomes compared to the non-Indigenous population. Malnutrition, and subsequently iron-deficiency anaemia, impairs childhood development. The aim of this study was to identify the prevalence of anaemia in school-aged children of an Australian Indigenous community and evaluate the effectiveness of treatment. DESIGN: A retrospective cohort study. SETTING: A Northern Territory Indigenous community. PARTICIPANTS: Two hundred and one school-age students (5-15 years old) undergoing annual school screening. MAIN OUTCOME MEASURES: Presence of anaemia. Anaemic and non-anaemic students were compared to determine any differences in age, gender, BMI and past history of anaemia. The response to treatment was analysed using initial and repeat haemoglobin results. RESULTS: Altogether, 201 students were screened with 105 (52%) classified as anaemic. No significant association was found between anaemic students and age, gender, BMI or prior history of anaemia. After treatment, the mean rise in haemoglobin was 13% (95% CI 11-15) at the 4-week interval. Age (P = 0.17), gender (P = 0.53) and weight (P = 0.14) were not significantly associated with treatment efficacy. Only 11 students (17%) were still anaemic after treatment. DISCUSSION: Anaemia in Indigenous Australian school-aged children is a major public health issue. The prevalence of anaemia in this population is 52% and many times higher than that of the general Australian population. As per current guidelines, the recommended treatment is effective in over 80% at the 4-week interval. Community wide interventions are required to combat this alarming issue.

Tweeting the meeting: A comparative analysis of an Australian emergency medicine conference over four years.

OBJECTIVE: Social media allows user-generated content and dialog between users and has also entered into the domain of healthcare. The purpose of this study was to compare the use of Twitter at the Australasian College of Emergency Medicine Annual Scientific Meeting (ACEM ASM) from 2011 to 2014 and analyze its ability to spread emergency medicine education. MATERIALS AND METHODS: Retrospectively, TweetReach was utilized to analyze relevant tweets. Each Annual Scientific Meeting (ASM) had an associated Twitter account/s from, which data were collected. Duplicate tweets were excluded from the analysis. Information on the number of total tweets (regular tweets, retweets, and replies) and contributors was gathered. The potential audience, the reach, was calculated. RESULTS: From 2011 to 2014 the number of tweets rose from 460 to 4694, a 920% increase. Only 54 Twitter users contributed to the 2011 ASM. This rose to 252 (2012), 291 (2013) and 572 (2014). The average number of tweets per contributor ranged from 8.2 to 10.9. The reach, the potential number of Twitter users exposed to posts, rose >30 times from 2011 (15,502 users) to 2014 (471,166). CONCLUSION: The use of Twitter at the ACEM ASM rose significantly from 2011 to 2014. It is a highly useful tool for the dissemination of emergency medicine education. Twitter has been harnessed by the ASM to enhance the conference experience by further generating interaction between delegates as well as those worldwide.

Subclavian artery injury secondary to clavicular plate fixation: a novel operative approach.

We present the case of a 32-year-old male with a delayed symptomatic left subclavian artery pseudoaneurysm secondary to protruding screws from prior perpendicular clavicular plate fixations. The pseudoaneurysm development and our operative approach are unique to the few similar cases available in the literature. The patient presented with a progressive pulsatile mass behind his left clavicle associated with paraesthesia. Angiography demonstrated a subclavian pseudoaneurysm adjacent to a prominent fixation screw. Offending screws were removed and the pseudoaneurysm was repaired using a reversed greater saphenous vein graft. This case illustrates an unusual aetiology for pseudoaneurysm development and highlights a successful operative intervention.

Stent graft infection secondary to appendicitis: an unusual complication of endovascular abdominal aortic aneurysm repair.

We present a case of a 73-year-old gentleman with an aortic endograft infection post endovascular abdominal aneurysm repair (EVAR), from whence erosion has come in from an acutely inflamed appendix. To our best understanding, there is no similar case published in the literature. Intra-operatively, there was obvious inflammation and oedema over the retroperitoneal tissue, with frank pus and thrombotic material projecting from the aorta. The tip of an obviously inflamed appendix had stuck to and eroded through the aortic sac, seeding the infection. The endograft was explanted and the aneurysm sac oversewn. Lower limb circulation was preserved with a right axillo-femoral Dacron bypass graft. This case highlights a rare complication following EVAR, and for one to consider unusual sources of graft infection.