Large intermuscular lipoma presenting as a groin hernia

Lipomas are the commonest benign mesenchymal tumours, commonly seen as a subcutaneous lump. However, intermuscular lipomas are uncommon and can remain asymptomatic until they attain larger sizes. We discuss a rare case of a large symptomatic intermuscular lipoma in a 34-year-old woman who presented with acute on chronic groin pain. Clinical examination findings were consistent with an incarcerated inguinal hernia and imaging confirmed a large intermuscular lipoma of the anterior abdominal wall, the tip of which herniated into the inguinal canal. She underwent open primary repair of the hernia along with excision of the lipoma. An intermuscular lipoma presenting as an incarcerated inguinal hernia at the first instance is an uncommon finding. Due to lack of obvious clinical findings, uncomplicated intermuscular lipomas can be challenging to diagnose until they become symptomatic, and a high degree of suspicion in patients reporting atypical abdominal and groin pain, or abdominal wall fullness is required

A case of amoebic colitis following remote historical exposure

A 67-year-old male with a background history of diverticular disease, atrial fibrillation and renal stones presented with dull lower abdominal pain associated with bloody diarrhoea following an episode of bilateral hip pain. He denied fevers, chills, pre-syncope, recent travel, gastroenteritis contacts and trauma. His medications included warfarin, metoprolol and rosuvastatin. He had not undergone prior colonoscopy or surgery. He had emigrated to Australia from Macedonia over 10 years ago

Comparison of the Safety and Efficacy of On-Pump (ONCAB) versus Off-Pump (OPCAB) Coronary Artery Bypass Graft Surgery in the Elderly: A Review of the ANZSCTS database

Background: The elderly population (age >70 years) incurs greater mortality and morbidity following CABG. OPCAB may mitigate these otucomes. A retrospective analysis of the results of OPCAB in this population was performed. Methods: We reviewed the Australian and New Zealand Society of Cardiac and Thoracic Surgeons’ (ANZSCTS) database for elderly patients (n=12697) undergoing isolated CABG surgery and compared the ONCAB (n=11676) with OPCAB (n=1021) technique. Preoperative and intraoperative risk factors, and postoperative outcomes were analysed. Survival analyses was performed after cross-matching the database with the national death registry to identify long-term mortality. Results: High-risk patients were more prevalent in the ONCAB group (p<0.05). OPCAB patients received fewer distal anastomoses than ONCAB patients (2.4±1.1 vs 3.3±1.0, p<0.001). Thirty-day mortality and stroke rates between OPCAB and ONCAB were not significantly different (2% vs 2.5% and 1.1% vs 1.8%, respectively). There was a non-significant trend towards improved 10-year survival in OPCAB patients using multivariate analysis (78.8% vs. 73.3%, p=0.076, HR 0.83; 95% CI 0.67-1.02). Conclusions: Mortality and stroke rates following CABG surgery are extremely low in the elderly suggesting that surgery is a safe management option for coronary artery disease in this population. OPCAB did not offer a significant advantage over ONCAB with regards to 30-day mortality, stroke and long-term survival. Further prospective randomised trials will be necessary to clarify risks or benefits in the elderly

Outcomes of On-Pump versus Off-Pump Coronary Artery Bypass Graft Surgery in the High Risk (AusSCORE &gt; 5)

Background: Coronary artery bypass graft surgery (CABG) has been established as the preferred intervention for coronary revascularisation in the high-risk population. OPCAB may further reduce mortality and morbidity in this population subgroup. This study presents the largest series of high-risk (AusSCORE &gt; 5) OPCAB patients in Australia and New Zealand. Methods: We reviewed the Australian and New Zealand Society of Cardiac and Thoracic Surgeons' (ANZSCTS) database for high-risk patients (n=7822) undergoing isolated CABG surgery and compared the ONCAB (n=7277) with the OPCAB (n=545) technique. Preoperative and intraoperative risk factors, and postoperative outcomes were analysed. Survival analysis was performed after cross-matching the database with the national death registry to identify long-term mortality. Results: The ONCAB and OPCAB groups had similar risk profiles based on the AusSCORE. Thirty-day mortality (ONCAB vs OPCAB 3.9% vs 2.4%, p=0.067) and stroke (ONCAB vs OPCAB 2.4% vs 1.3%, p=0.104) were similar between the two groups. OPCAB patients received fewer distal anastomoses than ONCAB patients (2.5±1.2 vs 3.3±1.0, p&lt;0.001). The rates of new postoperative atrial arrhythmia (28.3% vs 33.3%, p=0.017) and blood transfusion requirements (52.1% vs 59.5%, p=0.001) were lower in the OPCAB group, while duration of ICU stay in hours (97.4±187.8 vs 70.2±152.8, p&lt;0.001) was longer. There was a non-significant trend towards improved 10-year survival in OPCAB patients (74.7% vs. 71.7%, p=0.133). Conclusions: In the high-risk population, CABG surgery has a low rate of mortality and morbidity suggesting that surgery is a safe option for coronary revascularisation. OPCAB reduces postoperative morbidity and is a safe procedure for 30-day mortality, stroke and long-term survival in high-risk patients