Management of pleomorphic dermal sarcoma

xloma.fota13 shared this article with you from Inoreader Management of pleomorphic dermal sarcoma Via ANZ Journal of Surgery This study reviews the management of a rare skin tumour (pleomorphic dermal sarcoma) at a tertiary cancer centre. Abstract Background Pleomorphic dermal sarcoma (PDS) is a rare, poorly defined skin neoplasm with features similar to atypical fibroxanthoma, but with adverse histopathological characteristics indicating metastatic potential such as tumour necrosis, invasion beyond superficial subcutis or vascular and/or perineural infiltration. Optimal treatment for PDS is uncertain and reported outcomes vary due to the rarity of this diagnosis and uncertainty over histopathological categorization. The aim of this study was to review the clinical and histopathological features of PDS in a single Australian centre. Methods A retrospective review of all patients managed at the Peter MacCallum Cancer Centre with PDS between 2003 and 2017 was performed by a search of electronic records and histories reviewed. Results A total of 27 patients were identified, mostly elderly males (85.2%, mean age 79.8 years). Lesions were seen most commonly on the head and neck region (96.3%), predominantly on the scalp (63%). Mean tumour radial surgical excision margin was 12.8 mm. Eighteen patients (66.7%) underwent radiotherapy; 13 adjuvant, three neoadjuvant and two with palliative intent. After median follow‐up of 46.4 months, two patients had recurrence (7.4%); both had inadequate deep margins at first excision. There were three all‐cause deaths in the cohort. There was one disease‐specific mortality with metastatic PDS disease at the time of initial presentation. Conclusion PDS is a rare cutaneous malignancy most commonly found in the head and neck region in elderly men, which is best managed with adequate surgical excision. The role of radiotherapy is undefined and an area for future investigation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Necrotising fasciitis

xloma.fota13 shared this article with you from Inoreader Necrotising fasciitis deaths in Australia: patient characteristics and potential areas for improvement in clinical management Via ANZ Journal of Surgery Necrotising fasciitis continues to present a unique diagnostic challenge to clinicians across multiple specialties. A high index of suspicion for necrotising fasciitis, especially in high‐risk patients, urgent surgical review and aggressive debridement may reduce mortality. Abstract Background Necrotising fasciitis (NF) is a life‐threatening bacterial infection with high mortality. This retrospective study aimed to investigate patient characteristics and potential areas for improvement in clinical management in NF cases in Australia. Methods Retrospective analysis of surgical death data from all public and private Australian hospitals in every state and territory, excluding New South Wales, collected through the Australian and New Zealand Audit of Surgical Mortality for the 9‐year period, January 2009 to February 2018. Results A total of 290 NF cases were identified. Among these NF cases, obesity and diabetes mellitus were two of the most common comorbidities, with a prevalence of 26% and 41%, respectively. A total of 41 clinical management issues (CMIs) were identified among 36 NF cases. A larger proportion of NF cases had CMIs compared with non‐NF surgical mortality cases. Delay in diagnosis was the leading CMI (n = 28, 68.3%), followed by delay to surgery (n = 7, 17.1%). The majority of delayed diagnoses were attributed to non‐surgical clinicians in the hospital. Conclusion CMIs were identified in a larger proportion of NF cases than in other non‐NF surgical mortality cases, suggesting that there are areas for improvement in NF diagnosis and management in Australia. The leading potentially avoidable issue identified in NF deaths was delay in diagnosis. This highlights the importance of awareness among non‐surgical clinicians that NF is a surgical emergency requiring urgent debridement. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Normative data for the Nasal Obstruction Symptom Evaluation Scale

xloma.fota13 shared this article with you from Inoreader Normative data for the Nasal Obstruction Symptom Evaluation Scale in the general Australian population Via ANZ Journal of Surgery Recent changes to the Australian Medicare Benefits Scheme funding for rhinoplasty on November 2018 have included a Nasal Obstruction Symptom Evaluation (NOSE) Scale threshold of >45 as a criteria for surgical intervention. The NOSE Scale is a patient‐reported outcome measure of nasal obstruction which is well validated for use in rhinoplasty and septorhinoplasty patients. Up until now, however, there has been minimal normative data for the NOSE Scale in the general population and no normative data from the general Australian population published in the literature. This article provides that context, presenting the first normative NOSE Scale data for the general Australian population. Abstract Background Recent changes to the Australian Medicare Benefits Scheme have introduced the NOSE Score as a criteria threshold for funding rhinoplasty. On review of the literature, however, there is minimal normative Nasal Obstruction Symptom Evaluation (NOSE) score data to provide context for these changes. Methods Participants were recruited according to the general Australian population distribution of age (18–65 years), gender and geographical locations using the market research company Pureprofile. The data included demographic details, risk factors for nasal obstruction such as smoking, obstructive sleep apnoea, use of continuous positive airway pressure, history of nasal trauma, operations to the nose and a history of cleft lip/palate and each participant completed the NOSE Scale. Analysis of data included descriptive statistics, independent t‐tests and one‐way analysis of variances to assess differences in NOSE scores between risk factors. Results The NOSE score was completed by 247 males and 255 females with a mean age of 41(±13.39) years. The cohort had a mean NOSE score of 16 (±18.89) with a range from 0 to 95. A total of 48 respondents had a NOSE score greater than the Medicare threshold of >45. Cleft lip/palate, obstructive sleep apnoea and continuous positive airway pressure use were shown to have a statistically significant impact on NOSE score while other variables including body mass index, gender, smoking, location and other surgery to the nose were not shown to significantly impact results. Conclusions This study found that 9.6% of the general Australian population would have a NOSE score >45 and qualify for the Medicare Benefits Scheme rhinoplasty benefit. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outpatient surgical management of non‐melanoma skin cancers of the head and neck in a regional centre: an analysis of costs and outcomes

xloma.fota13 shared this article with you from Inoreader Outpatient surgical management of non‐melanoma skin cancers of the head and neck in a regional centre: an analysis of costs and outcomes Via ANZ Journal of Surgery This study presents the novel introduction of an outpatient‐based treatment model for non‐melanoma skin cancer in a regional ear, nose and throat department. Our reporting of non‐melanoma skin cancer lesions, associated margins and outcomes in conjunction with hospital inpatient versus outpatient costs and patient location linked to health service versus local primary care follow‐up, provides a presentation of this novel outpatient model for the consideration of its implementation in future planning and resource allocation. Abstract Background Non‐melanoma skin cancer is the most commonly diagnosed malignancy in Australia. Lesions of the head and neck are often outside the scope of primary care providers. The challenges of cancer care in regional Australia necessitate careful resource planning. This study presents an outpatient model that minimizes health service cost with local general practitioner follow‐up. Methods A retrospective review of 105 patients with 122 skin lesions in a dedicated Facial Lesion Assessment Management and Excision clinic was performed from July 2018 to 2019. Clinical outcomes, patient travel and cost analysis/comparison were recorded. Results There were 85 malignant cases with 59 basal cell carcinomas and 25 squamous cell carcinomas. For basal cell carcinoma, clear margins (≥3 mm), close margins (<3 mm) and positive margins were achieved in 24 (48%), 23 (46%) and three (6%) cases, respectively. For squamous cell carcinoma, clear margins (≥5 mm), close margins (<5 mm) and positive margins were achieved in seven (38.8%), 11 (61.1%) and none (0%) of the cases, respectively. Complications included one haematoma and two wound infections. For 37% of patients living >100 km from the department, 72.3% had local general practitioner follow‐up. Inpatient cost was $2870, $5697 and $9300 for primary closure, local flap and full‐thickness skin graft, respectively, and outpatient cost was $746 for a single facial lesion. Conclusion This study presents a cost‐effective model for the management of non‐melanoma skin cancers with improved departmental efficiency and streamlined patient care in an outpatient skin cancer management model in a regional centre. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Acinic cell carcinoma of the salivary gland

xloma.fota13 shared this article with you from Inoreader Acinic cell carcinoma of the salivary gland in the adult and paediatric population: a survival analysis Via ANZ Journal of Surgery Acinic cell carcinoma of the salivary gland is a rare but important clinical entity. A high‐grade variant exists that is associated with poorer outcomes particularly in those presenting with locally advanced disease. Excellent overall and disease‐free survival is achieved by surgery as the primary treatment modality. Abstract Background Acinic cell carcinoma (AcCC) is a rare malignant neoplasm of the salivary glands and generally considered to be a low‐grade tumour. Surgical treatment is often curative, but a more aggressive high‐grade variant has been associated with poorer survival and propensity for distant metastasis. No standard treatment guidelines exist and the approach to treatment is varied in the published series. The aim of this study is to present the experience of three major hospitals in Sydney, Australia, in treating AcCC of the salivary gland, with a focus on clinico‐pathological features of disease and their associations with survival outcomes. Methods Adult and paediatric cases of AcCC of the salivary gland during the time period 1979–2018 were retrospectively included. Demographic, clinico‐pathological, treatment and survival outcome data were extracted. Survival analysis was undertaken to assess the effect of clinical and pathological variables on overall and disease‐free survival. Results Thirty‐two cases were reviewed (29 adult and three paediatric). Thirty tumours (93.8%) were parotid gland primary tumours. Mean overall and disease‐free survival was 17.0 ± 0.7 and 16.0 ± 0.9 years, respectively. Features associated with poorer survival were cT staging >1, presence of preoperative clinical facial nerve deficit and local recurrence. Positive margins were associated with recurrence. Conclusion These data suggest that disease‐free and overall survival in AcCC of the salivary gland is excellent with surgery as the first‐line treatment. Poor survival outcomes are uncommon and may be associated with locally advanced disease in the presence of other well‐established high‐risk features. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Longitudinal versus transverse incision for common femoral artery exposure: a systematic review and meta‐analysis

xloma.fota13 shared this article with you from Inoreader Longitudinal versus transverse incision for common femoral artery exposure: a systematic review and meta‐analysis Via ANZ Journal of Surgery Longitudinal or transverse incisions are commonly used for common femoral artery exposure in vascular surgery. We perform a meta‐analysis and observed a higher risk of wound infection and wound dehiscence when a longitudinal incision is used. Abstract Background A longitudinal or a transverse incision is routinely used for common femoral artery (CFA) exposure. Some believe a transverse incision is associated with a lower incidence of postoperative complications. We performed a systematic review and meta‐analysis to evaluate the risk of postoperative surgical site infection, lymphatic complications, wound dehiscence and haematoma formation when using a longitudinal or transverse incision for CFA exposure. Methods Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines were adhered to. We searched various databases such as MEDLINE via PubMed and Embase for relevant studies from inception till 31 May 2020. Relevant search terms such as 'longitudinal', 'transverse', 'vertical', 'horizontal', 'femoral', 'incision' were used. We included both randomized controlled trials and case‐controlled studies, and extracted data related to study characteristics and postoperative complications. We assessed risk of bias using the Cochrane risk of bias tool and the Newcastle‐Ottawa scale. A random‐effects meta‐analysis was performed to obtain the pooled proportions and risk ratios (RR) for our study outcomes. Results We included seven studies with a total of 5922 groin incisions. A longitudinal incision was associated with a significantly higher incidence of wound infection (RR 2.93, 95% confidence interval (CI) 1.12–7.70, P = 0.03) and wound dehiscence (RR 2.87, 95% CI 1.06–7.77, P = 0.04). The risk of lymphatic complications (RR 1.09, 95% CI 0.39–3.05, P = 0.87) and wound haematoma (RR 2.85, 95% CI 0.88–9.21, P = 0.08) were similar. Conclusions A longitudinal incision may be associated with a higher incidence of wound infection and wound dehiscence, as compared to using a transverse incision for CFA exposure. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laparoscopic enucleation of pancreatic tumours

xloma.fota13 shared this article with you from Inoreader Laparoscopic enucleation of pancreatic tumours: a single‐institution experience of 66 cases Via ANZ Journal of Surgery The main concerns of laparoscopic enucleating an embedded tumour are non‐localization of the tumour and possible injury of the main pancreatic duct. Laparoscopic enucleation for an embedded tumour is technically feasible and safe through meticulous preoperative localization, careful manoeuvres during operation and the use of a 'crushing' technique, which does not increase the conversion rate and the incidence of complications and pancreatic fistula Abstract Background Laparoscopic enucleation of pancreatic tumours is seemingly a simple procedure, but challenging as the tumour is deeply embedded in the pancreatic parenchyma. Our study reports a single‐centre experience for these cases. Methods Cases with a tumour underwent laparoscopic enucleation from January 2014 to March 2020 in our hospital were collected and analysed. Results Sixty‐six cases were enrolled, including 21 men and 45 women with an average age of 43.6 ± 16.7 years old. The mean size of tumours was 2.7 ± 1.8 cm. The tumours were mainly located at the pancreatic head and neck (63.6%). The most common pathological diagnoses were insulinomas, followed by solid pseudopapillary tumours. Incidences of overall complications and pancreatic fistula (PF, Grade B) were 24.2% and 19.7%, respectively. No patient developed PF (Grade C) or died. Cases were divided into two groups according to whether the tumour was deeply embedded in the pancreas. Compared to the group with a superficial tumour (n = 36), the group with an embedded tumour (n = 30) had a longer operation time and drainage duration and a smaller tumour size (P < 0.05), but did not increase the incidence of complications and PF (Grade B/C). Conclusion Laparoscopic enucleation of tumours that were deeply embedded in the pancreas was technically feasible and safe. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Variations in intrinsic breast cancer characteristics in screen‐detected breast cancer patients aged between 45 and 69 and above the age of 70

xloma.fota13 shared this article with you from Inoreader Variations in intrinsic breast cancer characteristics in screen‐detected breast cancer patients aged between 45 and 69 and above the age of 70 Via ANZ Journal of Surgery Breast Screen Program in New Zealand targeted women aged 45 and 69 years. With increasing life expectancy, more old patients are diagnosed with breast cancer. Women aged 70 years or above tend to have a more favourable type of breast cancer. Abstract Background Increasing age is a well‐recognized risk factor for breast cancer. With an increase in life expectancy of women, more older patients are diagnosed with breast cancer. This study aimed to identify the variations in breast cancer attributes and mortality in different age groups in New Zealand. Methods This was a retrospective study of data from the Auckland Breast Cancer Register between 1 June 2000 and 28 February 2017. Patients who were diagnosed through Breast Screen were included. Group A included those aged between 45 and 69 years. Group B included individuals with an age of 70 years or above. Results From June 2000 to February 2017, a total of 6304 new cases of new breast cancer were diagnosed through Auckland Breast Screen, with 5788 patients in group A and 516 patients in group B. Group B was more likely to have the lower grade invasive cancers, with fewer grade 3 cancers. Oestrogen receptor positivity was more pronounced in group B, along with progesterone receptor positivity. Conversely, HER‐2 receptor was less likely to be positive in group B. There was a significantly higher breast cancer‐related mortality in group B (6.0% versus 2.7%). Mortality related to other causes was also much higher in group B as compared to that in group A (12.8% versus 2.5%). Conclusion Women aged 70 years or above generally tend to have a more favourable type of breast cancer, with a lower tumour grade, oestrogen and progesterone receptor positivity, and lower rate of HER‐2 overexpression. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ten‐year outcomes of the first ‘one‐stop haematuria clinic’ in an Australian public hospital

xloma.fota13 shared this article with you from Inoreader Ten‐year outcomes of the first 'one‐stop haematuria clinic' in an Australian public hospital Via ANZ Journal of Surgery Urgent assessment of haematuria is critical to exclude malignancy. We report the 10‐year prospectively collected outcomes from Australia's first dedicated one‐stop haematuria clinic at a tertiary‐level teaching hospital. This model of care serves as an effective tool for rapid, streamlined assessment of patients presenting with haematuria. Abstract Background Urgent assessment of haematuria is critical to exclude malignancy. The utilization of haematuria clinics in Australia remains in its infancy. It is hoped that the streamlined investigative service will achieve earlier diagnosis of urological malignancy and subsequently decrease morbidity and mortality. We report the 10‐year prospectively collected outcomes from Australia's first dedicated one‐stop haematuria clinic (OSHC). Methods Since its commencement in May 2008 through to July 2018, all consecutive patients assessed in the OSHC were included in the analysis. Data collected included demographics, presentation, wait times, investigation, assessment, initial treatment, referral and histopathology. Results A total of 3008 patients were seen in the OSHC with non‐visible haematuria (1024, 34%) and visible haematuria (1984, 66%). Three hundred and twenty‐seven (10.9%) patients were diagnosed with urothelial malignancy. In all, 306 (10.2%) patients had lower tract disease and 21 (0.7%) had upper tract disease. Urothelial cases were compiled of 123 (37.6%) Ta LG, 39 (11.9%) Ta HG, 21 (6.4%) Tis, 67 (20.5%) T1 and 77 (23.6%) T2–4. Urothelial malignancy was diagnosed more often in males (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.35–2.25), older patients elder than 60 years (OR 1.97, 95% CI 1.47–2.64) and patients with visible haematuria (OR 5.42, 95% CI 3.73–7.86). In all, 53.4% of patients were discharged after a single visit to the OSHC. Conclusion The OSHC has served as an effective tool for rapid, streamlined assessment of patients presenting with haematuria. This model of care has been subsequently adopted by numerous public centres across Australia. Current funding structures present a barrier to this excellent approach for rapid access diagnostics. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Part 2: blockchain technology in health care

xloma.fota13 shared this article with you from Inoreader Part 2: blockchain technology in health care Via ANZ Journal of Surgery Abstract Blockchain technology is one of the many disruptive technologies of the Fourth Industrial Revolution that will irrevocably change the way we live and work. These technologies are well embedded in the areas of global finance, health care and defence, to name a few. This review focuses on the relevance of blockchain technology to health care. Blockchain technology will be the unifying platform for sharing patient data currently inaccessible due to the siloed architecture of legacy software systems, and as a result potentially be the basis for precision or individualized patient treatment. It will also strengthen digital security of sensitive patient data that is presently a lucrative target for cyber criminals. In the current COVID‐19 environment, clinicians will rely more on telehealth to reduce person‐to‐person contact. This service can be delivered by the clinical team with confidence in the veracity of the patient data made accessible through the blockchain platform. Smart contracts written on the blockchain platform will reduce the possibility of international humanitarian aid to low‐ and middle‐income countries being misspent. The pharmaceutical supply chain industry is adopting blockchain technology to ensure supply chain provenance. Similarly, the health insurance industry recognizes how the blockchain ecosystem can improve services to its members and expedite reimbursements to clinicians. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Characteristics and survival prognosis of patients with pure squamous cell carcinoma of the gallbladder

xloma.fota13 shared this article with you from Inoreader Characteristics and survival prognosis of patients with pure squamous cell carcinoma of the gallbladder Via ANZ Journal of Surgery Pure squamous cell carcinoma of the gallbladder is rare and often confused with the adenosquamous carcinoma subtype in previous studies. Utilizing the Surveillance, Epidemiology, and End Results database, this study found that there were significant differences in the clinicopathological characteristics and survival prognosis between pure squamous cell carcinoma and adenosquamous carcinoma. Abstract Background Pure squamous cell carcinoma (SCC) of the gallbladder is rare and often confused with the adenosquamous carcinoma (ASC) subtype in previous studies. The present study was attempted to differentiate SCC from ASC by resolving their characteristics and prognosis. Methods The Surveillance, Epidemiology, and End Results database was queried for SCC and ASC of gallbladder cases from 1988 to 2015. Patients' clinicopathological characteristics and survival were analysed between the groups. Results Of the 709 patients with primary gallbladder cancer included in this study, 249 (35.1%) had pure SCC and the remaining 460 (64.9%) had ASC. It was found that pure SCC was associated with a larger median tumour size (58.0 versus 41.0 mm, P < 0.001), while ASC presented with a worse histological grade (47.4% versus 37.8% for grades III–IV, P = 0.019) and more lymph node invasion (27.4% versus 18.9%, P = 0.041). The 3‐year overall survival and disease‐specific survival rates in pure SCC were lower than those in ASC (7.5% versus 11.5% for overall survival, P < 0.001; 6.2% versus 10.9% for disease‐specific survival, P < 0.001). Multivariate analysis showed that early Surveillance, Epidemiology, and End Results historic stage, treatment with surgery and chemotherapy were significant favourable prognostic factors for pure SCC, while tumour size, late study period, treatment with surgery and radiotherapy were significant pr edictors for ASC. Conclusion There were significant differences in the clinicopathological characteristics and survival prognosis between pure SCC and ASC. Surgery combined with chemotherapy is the preferred treatment option for pure SCC. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.