BACKGROUND Chylous ascites is a rare complication in colorectal surgery with limited evidence.AIM To systematically review all available evidence to describe the incidence,clinical presentation,risk factors and manage...BACKGROUND Chylous ascites is a rare complication in colorectal surgery with limited evidence.AIM To systematically review all available evidence to describe the incidence,clinical presentation,risk factors and management strategies.METHODS The systematic review was performed through PubMed,MEDLINE,EMBASE and Cochrane and cross-checked up to November 2020.The data collated included:Demographics,indications(benign vs malignant),site of disease,surgical approach,extent of lymphadenectomy,day to and method of diagnosis of chylous ascites and management strategies.RESULTS A total of 28 studies were included in the final analysis(426 cases).Patient age ranged from 31 to 89 years.All except one case were performed for malignancy.Of the 426 cases,195 were right-colonic,121 left-colonic,103 pelvic surgeries and 7 others.The majority were diagnosed during the same inpatient stay by recognition of typical drain appearance and increased volume.Three cases were diagnosed during outpatient visits with increased abdominal distention and subsequently underwent paracentesis.Most cases were managed successfully non-operatively(fasting with prolonged drainage,total parenteral nutrition,somatostatin analogues or a combination of these).Only three cases required surgical intervention after failing conservative management and subsequently resolved completely.Risk factors identified include:Right-colonic surgery/tumour location,extent of lymphadenectomy and number of lymph nodes harvested.CONCLUSION Chylous ascites after colorectal surgery is a relatively rare complication.Whilst the majority of cases resolved without surgical intervention,preventative measures should be undertaken such as meticulous dissection and clipping of lymphatics during lymphadenectomy to prevent morbidity.展开更多
AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine.METHODS We performed an e...AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine.METHODS We performed an electronic literature search from Medline and Pub Med(via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: "surgery", "anaesthesia", "anesthesia", "anesthesiology", "anaesthesiology", "fluids", "fluid therapy", "crystalloid", "saline", "plasma-Lyte", "plasmalyte", "hartmann's", "ringers" "acetate", "gluconate", "malate", "lactate". All relevant articles were accessed in full. We summarized the data and reported the data in tables and text. RESULTS We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and text.CONCLUSION Plasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of PlasmaLyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed.展开更多
Background: Total hip arthroplasty (THA) is a common procedure that is increasingly being performed in younger patients. Deep acetabular reaming will result in more bone loss and the need for large acetabular componen...Background: Total hip arthroplasty (THA) is a common procedure that is increasingly being performed in younger patients. Deep acetabular reaming will result in more bone loss and the need for large acetabular components to be implanted. It can also lead to impingement, loosening, an altered center of rotation, and intraoperative periprosthetic fracture. The purpose of this study is to determine whether the single ream, robotic arm-assisted (RAA) THA can preserve a greater volume of bone stock compared to conventional hip replacement and resurfacing. Methods: We prospectively recruited 69 patients who had undergone primary THA using the Stryker Trident Acetabular System®in combination with the Stryker RAA System (MAKO)®and compared their mean reaming weight (g) with that of conventional hip replacement and resurfacing, as measured by Brennan et al. Comparison of acetabular reaming during hip resurfacing versus uncemented THA (J Orthop Surg. 2009;17(1): 42-46). Results: The mean reaming weight using the MAKO system was 9.08 g, which was 29% less than the reaming weight using uncemented THA and hip resurfacing of 12.75 g. None of the acetabular cups required screw fixation. During the 35-month follow-up period, there were no complications related to cup placement or positioning. Conclusions: The use of RAA THA results in statistically significant preservation of acetabular bone compared to conventional hip replacement and resurfacing. This approach reflects the increased precision offered by RAA single reaming. Surgeons may consider utilizing RAA THA, particularly in younger patients, to better preserve bone stock as this could potentially impact future revision procedures.展开更多
AIM To explore the birth experiences of teenage fathers and determine the extent to which they are prepared for childbirth.METHODS A mixed methods observational study was undertaken comparing the birth experience of 5...AIM To explore the birth experiences of teenage fathers and determine the extent to which they are prepared for childbirth.METHODS A mixed methods observational study was undertaken comparing the birth experience of 50 fathers in the setting of teenage pregnancy(teenage) compared to a group of 50 older fathers. Fathers were recruited in the antenatal period and completed structured questionnaires following the birth of their child. Quantitative and qualitative analysis was undertaken.RESULTS Teenage fathers were younger, less educated and less likely to attend prenatal childbirth education classes(P < 0.0001). During birth, they were less prepared and consulted by attending staff(both P < 0.05). They reported limited roles in intrapartum decision-making(< 20%). In multivariate analysis being a father in the setting of teenage pregnancy remained significantly associated with feeling unprepared for birth. The major themes in qualitative analysis were feeling unprepared,shock, fear, a sense of detachment, happiness, pride, love of the baby and satisfaction with fertility.CONCLUSION Teenage fathers are less prepared for the birth of their child and this results in shock, fear and detachment that may impact on the early father-infant relationship.展开更多
The rising tide of obesity has seen the prevalence of overweight and obese women presenting for antenatal care approach 50% in recent years. In addition, many pregnant women have gestational weight gain in excess of I...The rising tide of obesity has seen the prevalence of overweight and obese women presenting for antenatal care approach 50% in recent years. In addition, many pregnant women have gestational weight gain in excess of Institute of Medicine guidelines and develop obesity as a result of pregnancy. Both variables impact adversely upon pregnancy outcome. Individualised programs are not financially viable for cash strapped health systems. This review outlines an evidencebased, public health approach to the management of obesity in pregnancy. The interventions are affordable and in randomised and epidemiological trials, achieve benefits in pregnancy outcome.展开更多
Background: Operative vaginal delivery is a common obstetric intervention, with the potential to cause harm to mother and baby. Training in operative delivery traditionally comprised junior trainees learning the skill...Background: Operative vaginal delivery is a common obstetric intervention, with the potential to cause harm to mother and baby. Training in operative delivery traditionally comprised junior trainees learning the skills under supervision, then practicing and refining them independently. Recently this model has come under scrutiny, with the advent of simulation-based training suggesting a method by which the skills of safe delivery may be taught without risk. Multiple training courses exist, but few have been subjected to evaluation. Aims: The primary aim was to investigate if a simulation-based training workshop, where the development of a successful technique for vacuum delivery occurs using a collaborative, problem-solving approach, improves the rate of correct vacuum cup placement. The secondary aim was to determine if the workshop leads to improvement in theoretical knowledge of vacuum delivery. Methods: Participants on three workshops were assessed for their performance in vacuum delivery prior to and following a multimodal training program. Participants included general practitioner obstetricians, obstetric trainees and resident medical officers. Evaluation occurred using a standardised Likert-scaled rating sheet and utilising a diagrammatic representation of cup placement. Results: The participants demonstrated significant improvement (median post-pre score 1, p in the accuracy of cup placement, in a variety of practical core skills and in theoretical knowledge of vacuum delivery. Discussion: Participation in a simulation-based vacuum delivery workshop improves the performance of obstetric trainees and GP obstetricians. Further work is required to evaluate the performance of such training modalities on clinically relevant outcomes.展开更多
文摘BACKGROUND Chylous ascites is a rare complication in colorectal surgery with limited evidence.AIM To systematically review all available evidence to describe the incidence,clinical presentation,risk factors and management strategies.METHODS The systematic review was performed through PubMed,MEDLINE,EMBASE and Cochrane and cross-checked up to November 2020.The data collated included:Demographics,indications(benign vs malignant),site of disease,surgical approach,extent of lymphadenectomy,day to and method of diagnosis of chylous ascites and management strategies.RESULTS A total of 28 studies were included in the final analysis(426 cases).Patient age ranged from 31 to 89 years.All except one case were performed for malignancy.Of the 426 cases,195 were right-colonic,121 left-colonic,103 pelvic surgeries and 7 others.The majority were diagnosed during the same inpatient stay by recognition of typical drain appearance and increased volume.Three cases were diagnosed during outpatient visits with increased abdominal distention and subsequently underwent paracentesis.Most cases were managed successfully non-operatively(fasting with prolonged drainage,total parenteral nutrition,somatostatin analogues or a combination of these).Only three cases required surgical intervention after failing conservative management and subsequently resolved completely.Risk factors identified include:Right-colonic surgery/tumour location,extent of lymphadenectomy and number of lymph nodes harvested.CONCLUSION Chylous ascites after colorectal surgery is a relatively rare complication.Whilst the majority of cases resolved without surgical intervention,preventative measures should be undertaken such as meticulous dissection and clipping of lymphatics during lymphadenectomy to prevent morbidity.
文摘AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine.METHODS We performed an electronic literature search from Medline and Pub Med(via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: "surgery", "anaesthesia", "anesthesia", "anesthesiology", "anaesthesiology", "fluids", "fluid therapy", "crystalloid", "saline", "plasma-Lyte", "plasmalyte", "hartmann's", "ringers" "acetate", "gluconate", "malate", "lactate". All relevant articles were accessed in full. We summarized the data and reported the data in tables and text. RESULTS We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and text.CONCLUSION Plasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of PlasmaLyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed.
文摘Background: Total hip arthroplasty (THA) is a common procedure that is increasingly being performed in younger patients. Deep acetabular reaming will result in more bone loss and the need for large acetabular components to be implanted. It can also lead to impingement, loosening, an altered center of rotation, and intraoperative periprosthetic fracture. The purpose of this study is to determine whether the single ream, robotic arm-assisted (RAA) THA can preserve a greater volume of bone stock compared to conventional hip replacement and resurfacing. Methods: We prospectively recruited 69 patients who had undergone primary THA using the Stryker Trident Acetabular System®in combination with the Stryker RAA System (MAKO)®and compared their mean reaming weight (g) with that of conventional hip replacement and resurfacing, as measured by Brennan et al. Comparison of acetabular reaming during hip resurfacing versus uncemented THA (J Orthop Surg. 2009;17(1): 42-46). Results: The mean reaming weight using the MAKO system was 9.08 g, which was 29% less than the reaming weight using uncemented THA and hip resurfacing of 12.75 g. None of the acetabular cups required screw fixation. During the 35-month follow-up period, there were no complications related to cup placement or positioning. Conclusions: The use of RAA THA results in statistically significant preservation of acetabular bone compared to conventional hip replacement and resurfacing. This approach reflects the increased precision offered by RAA single reaming. Surgeons may consider utilizing RAA THA, particularly in younger patients, to better preserve bone stock as this could potentially impact future revision procedures.
文摘AIM To explore the birth experiences of teenage fathers and determine the extent to which they are prepared for childbirth.METHODS A mixed methods observational study was undertaken comparing the birth experience of 50 fathers in the setting of teenage pregnancy(teenage) compared to a group of 50 older fathers. Fathers were recruited in the antenatal period and completed structured questionnaires following the birth of their child. Quantitative and qualitative analysis was undertaken.RESULTS Teenage fathers were younger, less educated and less likely to attend prenatal childbirth education classes(P < 0.0001). During birth, they were less prepared and consulted by attending staff(both P < 0.05). They reported limited roles in intrapartum decision-making(< 20%). In multivariate analysis being a father in the setting of teenage pregnancy remained significantly associated with feeling unprepared for birth. The major themes in qualitative analysis were feeling unprepared,shock, fear, a sense of detachment, happiness, pride, love of the baby and satisfaction with fertility.CONCLUSION Teenage fathers are less prepared for the birth of their child and this results in shock, fear and detachment that may impact on the early father-infant relationship.
文摘The rising tide of obesity has seen the prevalence of overweight and obese women presenting for antenatal care approach 50% in recent years. In addition, many pregnant women have gestational weight gain in excess of Institute of Medicine guidelines and develop obesity as a result of pregnancy. Both variables impact adversely upon pregnancy outcome. Individualised programs are not financially viable for cash strapped health systems. This review outlines an evidencebased, public health approach to the management of obesity in pregnancy. The interventions are affordable and in randomised and epidemiological trials, achieve benefits in pregnancy outcome.
文摘Background: Operative vaginal delivery is a common obstetric intervention, with the potential to cause harm to mother and baby. Training in operative delivery traditionally comprised junior trainees learning the skills under supervision, then practicing and refining them independently. Recently this model has come under scrutiny, with the advent of simulation-based training suggesting a method by which the skills of safe delivery may be taught without risk. Multiple training courses exist, but few have been subjected to evaluation. Aims: The primary aim was to investigate if a simulation-based training workshop, where the development of a successful technique for vacuum delivery occurs using a collaborative, problem-solving approach, improves the rate of correct vacuum cup placement. The secondary aim was to determine if the workshop leads to improvement in theoretical knowledge of vacuum delivery. Methods: Participants on three workshops were assessed for their performance in vacuum delivery prior to and following a multimodal training program. Participants included general practitioner obstetricians, obstetric trainees and resident medical officers. Evaluation occurred using a standardised Likert-scaled rating sheet and utilising a diagrammatic representation of cup placement. Results: The participants demonstrated significant improvement (median post-pre score 1, p in the accuracy of cup placement, in a variety of practical core skills and in theoretical knowledge of vacuum delivery. Discussion: Participation in a simulation-based vacuum delivery workshop improves the performance of obstetric trainees and GP obstetricians. Further work is required to evaluate the performance of such training modalities on clinically relevant outcomes.
