Identifying recurrences and metastasis after ductal carcinoma in situ (DCIS) of the breast.

Ductal carcinoma in situ (DCIS) of the breast is a non-invasive tumour that has the potential to progress to invasive ductal carcinoma (IDC). Thus, it represents a treatment dilemma: alone it does not present a risk to life, however, left untreated it may progress to a life-threatening condition. Current clinico-pathological features cannot accurately predict which patients with DCIS have invasive potential, and therefore clinicians are unable to quantify the risk of progression for an individual patient. This leads to many women being over-treated, while others may not receive sufficient treatment to prevent invasive recurrence. A better understanding of the molecular features of DCIS, both tumour-intrinsic and the microenvironment, could offer the ability to better predict which women need aggressive treatment, and which can avoid therapies carrying significant side-effects and such as radiotherapy. In this review, we summarise the current knowledge of DCIS, and consider future research directions.

Pancolitis Post COVID-19 Infection: A Case Report.

Gastrointestinal tract (GIT) symptoms are increasingly reported as the presenting symptoms of coronavirus disease 2019 (COVID-19). These symptoms vary from diarrhea to severe colitis or bleeding. This paper reports a rare case of pancolitis as a consequence of GIT involvement secondary to active COVID-19 in a previously healthy 52-year-old lady. The diagnosis was confirmed by a CT scan of the abdomen and the patient was hospitalized and treated conservatively and discharged home after three days of hospital admission. She was followed up in the outpatient surgical clinic in two weeks with no more gastrointestinal symptoms and a normal physical examination. Careful consideration of gastrointestinal symptoms in the context of COVID-19 and a prompt diagnosis will facilitate early recognition and management and avoid any sinister complications.

The Role of CT cholangiography in the Detection and Localisation of Suspected Bile Leakage Following Cholecystectomy.

BACKGROUND: Most bile duct injuries are not recognized at the time of initial surgery. Optimal treatment requires early recognition. CT IVC has become increasingly important in identifying bile leaks and their source after cholecystectomy. Our study aims to report the outcomes of using CT IVC post operatively and how accurately it can detect or localise bile leaks. METHODS: From 2000 - 2009, twenty patients were managed for suspected bile leak post cholecystectomy within the Alfred Hospital. The study included a retrospective evaluation of the initial procedure, presenting symptoms, site of ductal injury, diagnostic procedures and therapeutic interventions. Results were analysed to determine success of the imaging procedure, and to correlate imaging diagnosis with results both diagnostically and clinically. RESULTS: Twenty patients had a suspected bile leak, of which 3 were detected at the time of surgery. Seven patients had a CTIVC as their primary investigation. It identified bile leak in 6 and the anatomical site in 5. One had a leak excluded and was managed conservatively. CONCLUSIONS: CT Cholangiography is a feasible and low-risk tool for imaging of the biliary tract in suspected bile leaks post cholecystectomy. It is a valuable non-invasive investigation that may help avoid endoscopic retrograde Cholangiography or surgery.

Emergency department staff can effectively resuscitate in level C personal protective equipment.

OBJECTIVE: ED staff are expected to perform resuscitation of trauma victims of chemical, biological and radiation incidents while wearing level C personal protective equipment (PPE). The present project assessed the subjective discomfort, physiological impact and performance of staff wearing PPE. METHODS: A paired intervention study of ED staff in a resuscitation scenario comparing task performance wearing gown and gloves with PPE. Data were collected using a structured self-administered questionnaire and by objective and subjective measurements. RESULTS: Seven ED doctors and 11 ED nurses were enrolled. Nine had previous PPE training although only one had used PPE clinically. Overall, ED staff felt that PPE did not affect their ability to perform trauma resuscitation. For individual tasks, staff felt that PPE impaired assessment of pulse, i.v. cannulation, i.v. line attachment, use of a mini-jet, bag and mask ventilation, and communication. However, the only objective difference in task performance was time to control haemorrhage (increase from 38 to 47 s, P = 0.02). PPE was well tolerated, with minimal physiological or psychological impact. Staff wore PPE for a median of 37 min (interquartile range: 33-38) and estimated that PPE could be worn for a further 30 min if required. CONCLUSIONS: ED staff are able to perform resuscitation procedures in PPE without adverse physiological effects or impact on performance. Subjective concerns regarding task performance were not reflected in objective measurements. This might indicate that appropriate training and feedback could reduce the negative impression associated with activities undertaken while wearing PPE.