An unusual cause of collapsed lung after transhiatal oesophagectomy: a case report

Transhiatal oesophagectomy is an established technique for resection of tumours of the lower oesophagus and oesophagogastric junction. The authors describe a previously unreported serious complication associated with placement of a corrugated neck drain during transhiatal oesophagectomy. A 63 year old man was admitted for transhiatal oesophagectomy for resection of a lower third oesophageal tumour. Post operatively he developed a left sided pneumothorax which did not improve despite numerous chest drains. The subcutaneous corrugated neck drain was removed with immediate inflation of the lung. We report an important potential complication that surgeons in several specialties should be aware of, especially in the use of corrugated neck drains following transhiatal oesophagectomy

High Post-Capture Survival for Sharks, Rays and Chimaeras Discarded in the Main Shark Fishery of Australia?

Most sharks, rays and chimaeras (chondrichthyans) taken in commercial fisheries are discarded (i.e. returned to the ocean either dead or alive). Quantifying the post-capture survival (PCS) of discarded species is therefore essential for the improved management and conservation of this group. For all chondrichthyans taken in the main shark fishery of Australia, we quantified the immediate PCS of individuals reaching the deck of commercial shark gillnet fishing vessels and applied a risk-based method to semi-quantitatively determine delayed and total PCS. Estimates of immediate, delayed and total PCS were consistent, being very high for the most commonly discarded species (Port Jackson shark, Australian swellshark, and spikey dogfish) and low for the most important commercial species (gummy and school sharks). Increasing gillnet soak time or water temperature significantly decreased PCS. Chondrichthyans with bottom-dwelling habits had the highest PCS whereas those with pelagic habits had the lowest PCS. The risk-based approach can be easily implemented as a standard practice of on-board observing programs, providing a convenient first-step assessment of the PCS of all species taken in commercial fisheries

The relationship between patient physiology, the systemic inflammatory response and survival in patients undergoing curative resection of colorectal cancer

<p>Background: It is increasingly recognised that host-related factors may be important in determining cancer outcome. The aim was to examine the relationship between patient physiology, the systemic inflammatory response and survival after colorectal cancer resection.</p> <p>Methods: Patients undergoing potentially curative resection of colorectal cancer were identified from a prospectively maintained database. Patient physiology was assessed using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) criteria. The systemic inflammatory response was assessed using the modified Glasgow Prognostic Score (mGPS). Multivariate 5-year survival analysis was carried out with calculation of hazard ratios (HR).</p> <p>Results: A total of 320 patients were included. During follow-up (median 74 months), there were 136 deaths: 83 colorectal cancer related and 53 non-cancer related. Independent predictors of cancer-specific survival were age (HR: 1.46, P<0.01), Dukes stage (HR: 2.39, P<0.001), mGPS (HR: 1.78, P<0.001) and POSSUM physiology score (HR: 1.38, P=0.02). Predictors of overall survival were age (HR: 1.64, P<0.001), smoking (HR: 1.52, P=0.02), Dukes stage (HR: 1.64, P<0.001), mGPS (HR: 1.60, P<0.001) and POSSUM physiology score (HR: 1.27, P=0.03). A relationship between mGPS and POSSUM physiology score was also established (P<0.006).</p> <p>Conclusion: The POSSUM physiology score and the systemic inflammatory response are strongly associated and both are independent predictors of cancer specific and overall survival in patients undergoing potentially curative resection of colorectal cancer.</p&gt

Proposed follow up programme after curative resection for lower third oesophageal cancer

The incidence of oesophageal adenocarcinoma has risen throughout the Western world over the last three decades. The prognosis remains poor as many patients are elderly and present with advanced disease. Those patients who are suitable for resection remain at high risk of disease recurrence. It is important that cancer patients take part in a follow up protocol to detect disease recurrence, offer psychological support, manage nutritional disorders and facilitate audit of surgical outcomes. Despite the recognition that regular postoperative follow up plays a key role in ongoing care of cancer patients, there is little consensus on the nature of the process. This paper reviews the published literature to determine the optimal timing and type of patient follow up for those after curative oesophageal resection

Towards screening Barrett’s Oesophagus: current guidelines, imaging modalities and future developments

Barrett’s oesophagus is the only known precursor to oesophageal adenocarcinoma (OAC). Although guidelines on the screening and surveillance exist in Barrett’s oesophagus, the current strategies are inadequate. Oesophagogastroduodenoscopy (OGD) is the gold standard method in screening for Barrett’s oesophagus. This invasive method is expensive with associated risks negating its use as a current screening tool for Barrett’s oesophagus. This review explores current definitions, epidemiology, biomarkers, surveillance, and screening in Barrett’s oesophagus. Imaging modalities applicable to this condition are discussed, in addition to future developments. There is an urgent need for an alternative non-invasive method of screening and/or surveillance which could be highly beneficial towards reducing waiting times, alleviating patient fears and reducing future costs in current healthcare services. Vibrational spectroscopy has been shown to be promising in categorising Barrett’s oesophagus through to high-grade dysplasia (HGD) and OAC. These techniques need further validation through multicentre trials

Perineal Metastatic Crohn's Disease: A Case Report and Review of the Literature

Metastatic Crohn's disease is an uncommon complication of Crohn's disease defined as granulomatous inflammation not contiguous with inflammatory disease in bowel. We report on the presentation and management of a 36-year-old man, who had undergone panproctocolectomy 11 years ago, with complex fistulous disease in his perineum, which demonstrated granulomas histologically after resection. We review six similar case reports. Optimal treatment would appear to be by surgical debridement