Cutaneous Stomal Recurrence of Colorectal Cancer After Curative Rectal Cancer Surgery - A Case Report and Systematic Review.

BACKGROUND/AIM: Stomal metastases from a primary rectal adenocarcinoma are rare, therefore, clear guidelines on treatment options are limited. We performed a systematic review including a case report on this subject with the primary objective of identifying the total number of cases in the literature. The secondary objective was to assess median survival. MATERIALS AND METHODS: A 59-year-old woman presented to our institution with anal incontinence to mucus leakage. Flexible sigmoidoscopy identified a carpet adenoma from the dentate line to the rectosigmoid junction. An abdomino-perineal resection (APR) was performed using the transanal total mesorectal excision technique (TaTME). No adjuvant chemotherapy was offered. Twenty-one months following the operation a stomal recurrence was identified. Palliative radiotherapy was commenced and the patient is alive 6 months later with no visible recurrence at the site of the stoma. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. RESULTS: The systematic review identified 19 individual cases of either metachronous or true metastatic recurrence, including our own case. Median survival was 30 months in the 8 cases where further treatment was offered and accepted. CONCLUSION: Stomal metastases or metachronous colorectal cancer is uncommon. The causes for this pattern of spread are not clear. Long-term survival from cutaneous recurrence is generally poor. For carefully selected patients, redo surgery is an option with satisfactory results.

Comparison of Patient Satisfaction on a Day-case Mastectomy Pathway for Breast Cancer Versus a Traditional Inpatient Delivery Model, Using a Validated Questionnaire.

BACKGROUND: In 2011, a guidance was issued by the National Health Service (NHS) Improvement a model on how mastectomy could be offered in the day-case setting. The goal of this guidance was to reduce inpatient bed days and cost to the NHS, and demonstrate that it can be performed within an acceptable safety profile. The aim of this study was to assess whether patients find the day-case pathway for mastectomy an acceptable management model. We compared complication rates between the day-case and inpatient delivery model. PATIENTS AND METHODS: This study was a retrospective analysis of patients' experience undergoing day-case (n=26) and inpatient mastectomy (n=60). The primary outcome measure was based on a telephone interview using a validated, standardised questionnaire. RESULTS: No statistically significant difference in the satisfaction levels between the two groups (raw scores 6.76 day-case vs. 6.15 inpatient, p=0.37) was demonstrated. We found no statistically significant difference between the two groups when specifically analysing whether patients found the first night harder as a day-case or inpatient (3.192 vs. 2.80, p=0.59, range 0-10). Our overall complications were 11.4% (day-case) and 18.3% (inpatients). Rates were comparable between the two groups and equivalent to published rates in the literature. CONCLUSION: There was no statistically significant difference in satisfaction scores between patients who had a mastectomy as an inpatient versus those who had their operation as a day-case procedure. In addition, there were no significant differences in the complication rates between the two groups. We conclude then that it is feasible and safe to offer day-case mastectomy, with no loss in patient satisfaction.

A theory-based behavior-change intervention to reduce alcohol consumption in undergraduate students: trial protocol.

BACKGROUND: Excessive alcohol consumption on single occasions among undergraduate students is a major health issue as research has shown this pattern of drinking to be related to maladaptive health and psychosocial outcomes. Brief, theory-based interventions targeting motivation and self-control as behavior-change techniques have been identified as effective means to reduce alcohol consumption, but few studies have examined the interactive effects of these components. The aim of the present study is to develop a brief theory-based intervention using motivational and self-control intervention techniques to reduce alcohol consumption in undergraduate students. METHODS/DESIGN: The intervention will adopt a factorial design to test the main and interactive effects of the techniques on alcohol consumption. Using mental simulations and the strength model of self-control as the theoretical bases of the intervention, the study will adopt a fully randomized 2 (mental simulation: mental simulation vs. control irrelevant visualization exercise) × 2 (self-control training: challenging Stroop task vs. easy Stroop task) between-participants design. Non-abstinent undergraduate students aged 18 years or older will be eligible to participate in the study. Participants will complete an initial survey including self-reported alcohol consumption measures, measures of motivation and self- measures. Participants will be randomly allocated to receive either a mental simulation exercise presented in print format or a control irrelevant visualization exercise. Thereafter, participants will be randomly assigned to receive a challenging online self-control training exercise or an easy training exercise that has little self-control demand over the course of the next four weeks. Four weeks later participants will complete a follow-up alcohol consumption, motivation and self-control measures. DISCUSSION: This study will provide the first evidence for the individual and interactive effects of motivational and self-control training techniques in an intervention to reduce alcohol consumption. It will also demonstrate the importance of adopting multiple theoretical perspectives and a factorial design to identify the unique and interactive impact of behavior-change techniques on health behavior. TRIAL REGISTRATION: The trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12613000573752.

Massive traumatic abdominal hernia repair with biologic mesh.

Traumatic abdominal wall hernias (TAWHs) are rare. They can arise from either high or low impact trauma and can be associated with significant associated injury. We present the case of a 27-year-old male involved in a high-impact road traffic accident resulting in a TAWH. He sustained significant disruption to the abdominal wall and sustained injuries to the thoracic cage. Operative management was undertaken with a porcine dermal collagen mesh, using a bridge technique.