Combining the quantitative faecal immunochemical test and full blood count reliably rules out colorectal cancer in a symptomatic patient referral pathway

Purpose: Faecal Immunochemical Test (FIT) has proven utility for Colorectal Cancer (CRC) detection in symptomatic patients. Most studies have examined FIT in symptomatic patients subsequently referred from primary care. We investigated associations between CRC and FIT in both referred and non-referred symptomatic patients. Methods: A retrospective, observational study of all patients with a FIT submitted Aug 2018 to Jan 2019 in NHS GG&C was performed. Referral to colorectal/gastroenterology and decision to perform colonoscopy were recorded. FIT results were grouped as f-Hb < 10/10–149/150–399/ ≥ 400 μg/g. The MCN cancer registry identified new cases of CRC. Covariables were compared using the χ2 test. Multivariate binary logistic regression identified independent predictors of CRC. Results: A total of 4968 patients were included. Raised FIT correlated with decision to refer (p < 0.001) and scope (p < 0.001). With 23-month median follow-up, 61 patients were diagnosed with CRC. These patients were older (median 69 vs 59 years, cancer and no cancer respectively, p = 0.001), more likely to be male (55.7% vs 42.1%, p = 0.033), and to report rectal bleeding (51.7% vs 36.1%, p = 0.013). FIT (< 10 µg/g 8.2% vs 76.7% and ≥ 400 µg/g 55.7% vs 3.8%, p < 0.001) and anaemia (45.9% vs 19.7%, p < 0.001) were associated with CRC. On multivariate analysis, age (p = 0.023), male sex (p = 0.04), FIT (≥ 400 OR 54.256 (95% CI:20.683–142.325; p < 0.001)), and anaemia (OR 1.956 (1.071–3.574; p = 0.029)) independently predicted CRC. One patient (0.04%) with a negative FIT and normal haemoglobin had CRC. Conclusion: GP referral and secondary care investigation patterns were influenced by FIT. The combination of normal Hb and f-Hb excluded CRC in 99.96% of cases, providing excellent reassurance to those prioritising access to endoscopy services

Deep Learning for Automated Boundary Detection and Segmentation in Organ Donation Photography

Background: Medical photography is ubiquitous and plays an increasingly important role in the fields of medicine and surgery. Any assessment of these photographs by computer vision algorithms requires first that the area of interest can accurately be delineated from the background. We aimed to develop deep learning segmentation models for kidney and liver retrieval photographs where accurate automated segmentation has not yet been described. Methods: Two novel deep learning models (Detectron2 and YoloV8) were developed using transfer learning and compared against existing tools for background removal (macBGRemoval, remBGisnet, remBGu2net). Anonymized photograph datasets comprised training/internal validation sets (821 kidney and 400 liver images) and external validation sets (203 kidney and 208 liver images). Each image had two segmentation labels: whole organ and clear view (parenchyma only). Intersection over Union (IoU) was the primary outcome, as the recommended metric for assessing segmentation performance. Results: In whole kidney segmentation, Detectron2 and YoloV8 outperformed other models with internal validation IoU of 0.93 and 0.94, and external validation IoU of 0.92 and 0.94, respectively. Other methods—macBGRemoval, remBGisnet, and remBGu2net—scored lower, with highest internal validation IoU at 0.54 and external validation at 0.59. Similar results were observed in liver segmentation, where Detectron2 and YoloV8 both showed internal validation IoU of 0.97 and external validation of 0.92 and 0.91, respectively. The other models showed a maximum internal validation and external validation IoU of 0.89 and 0.59 respectively. All image segmentation tasks with Detectron2 and YoloV8 completed within 0.13 to 1.5 seconds per image. Conclusions: Accurate, rapid, and automated image segmentation in the context of surgical photography is possible with open-source deep-learning software. These outperform existing methods, and could impact the field of surgery, enabling similar advancements seen in other areas of medical computer vision

A rare case of simultaneous pneumoperitoneum and pneumomediastinum with a review of the literature

Simultaneous pneumoperitoneum and pneumomediastinum is a rare clinical occurrence. It has been reported in the literature as a complication of various medical and dental procedures. To our knowledge, we present the first case of a non-iatrogenic and traumatic simultaneous pneumoperitoneum and pneumomediastinum in a previously independent 91-year-old man who presented to hospital with back and chest wall pain following mechanical fall from standing. A new radiological diagnosis of diverticular disease with possible perforation was made following admission. Despite appropriate management and supportive measures, the patient died 12 days after admission from a kidney injury

Persistent knee effusion in a young female

No abstract available

Choledocholithiasis: Long term follow up in patients without stone clearance at first ERCP

Objectives: Complete clearance during index ERCP for choledocholithiasis is not always successful and biliary stenting is commonplace. Strategies vary between temporary stent placement (TSP) with interval ERCP or permanent stent placement (PSP) and watchful waiting for recurrent biliary obstruction (RBO). This study aimed to describe outcomes between these groups, and stent patency rates in the PSP group. Methods: All patients with incomplete clearance at first ERCP for choledocholithiasis between May 2015 and December 2018 were identified from a prospectively collected single-centre database. Clinical outcomes were obtained by retrospective interrogation of case notes. Median follow-up was 41(IQR:29–51) months. Results: Of 1263 index ERCPs, 199(15.8%) concluded without stone clearance. All received biliary stenting, 106/199(53%) as PSP and 93/199(47%) with TSP. The TSP group had repeat ERCP after median 8(IQR:6–15) weeks; 70/93(75%) had clearance on repeat ERCP. Median age was greater in the PSP v TSP group (82 v 72 years, p < 0.05). Rates of RBO (32.1 v 16.1%, p < 0.05), and emergency readmissions (32.1 v 19.4%, p < 0.05) were greater in the PSP group. More patients died without further biliary disease in the PSP group (39.6 v 12.9%, p < 0.05). PSP stent patency rates at 6, 12, 24, 36, and 61 months were 87.7%, 82.1%, 75.5%, 69.8% and 67.9% respectively. Conclusions: Though PSP had higher RBO and emergency readmissions, 2/3 of these patients either died or survive without recurrent biliary disease. Stent patency decreased fastest in the first 12 months. Patient criteria to guide decision making regarding biliary stenting remain unclear

Complex regional pain syndrome in a young female

No abstract available

Donor Blood Tests do Not Predict Pancreas Graft Survival After Simultaneous Pancreas Kidney Transplantation; a National Cohort Study

Copyright \ua9 2024 Ho, Tingle, Malik, Thompson, Kourounis, Amer, Pandanaboyana, Wilson and White.Simultaneous pancreas-kidney (SPK) transplantation improves quality of life and limits progression of diabetic complications. There is reluctance to accept pancreata from donors with abnormal blood tests, due to concern of inferior outcomes. We investigated whether donor amylase and liver blood tests (markers of visceral ischaemic injury) predict pancreas graft outcome using the UK Transplant Registry (2016-2021). 857 SPK recipients were included (619 following brainstem death, 238 following circulatory death). Peak donor amylase ranged from 8 to 3300 U/L (median = 70), and this had no impact on pancreas graft survival when adjusting for multiple confounders (aHR = 0.944, 95% CI = 0.754–1.81). Peak alanine transaminases also did not influence pancreas graft survival in multivariable models (aHR = 0.967, 95% CI = 0.848–1.102). Restricted cubic splines were used to assess associations between donor blood tests and pancreas graft survival without assuming linear relationships; these confirmed neither amylase, nor transaminases, significantly impact pancreas transplant outcome. This is the largest, most statistically robust study evaluating donor blood tests and transplant outcome. Provided other factors are acceptable, pancreata from donors with mild or moderately raised amylase and transaminases can be accepted with confidence. The use of pancreas grafts from such donors is therefore a safe, immediate, and simple approach to expand the donor pool to reach increasing demands