Isolated splenic hydatid disease: a rare case in rural New Zealand.

Nil.

A multicentre, benchmarking study of rectal cancer management in provincial New Zealand hospitals.

AIM: The quality of rectal cancer management within New Zealand provincial hospitals is largely unknown. This study was conducted to appraise and benchmark the management of rectal cancer in provincial New Zealand centres as compared to specialist tertiary centres. METHOD: Retrospective data was collected for all patients who underwent elective rectal cancer resection in six provincial New Zealand hospitals from January 2012 to December 2013. This was then compared with data from two tertiary hospitals over the same time period. The complete management pathway was evaluated. RESULTS: A total of 124 provincial and 145 tertiary rectal cancer resections were analysed. Completeness of preoperative staging was comparable between provincial and tertiary centres, as was type of surgical procedure performed and rates of clear surgical margins. A statistically significant difference was observed in mean number of lymph nodes analysed (10.3 v 17.2), reporting of mesorectal grade (61% v 77%), and completion colonoscopy rates (91% v 99%), all of which were lower in provincial hospitals. Multidisciplinary team discussion, rates of neoadjuvant therapy and post-operative parameters such as 30-day mortality (0.8% v 1.4%), length of stay (11.9 v 12.4 days), anastomotic leak (7% v 5%) and return to theatre (8% v 8%), were similar. CONCLUSION: Management of rectal cancer in provincial hospitals is comparable to specialist centres, however lymph node harvest, reporting of mesorectal grade and complete colonoscopy were factors identified which were lower in the provincial group. Provincial rectal cancer management remains an important resource for patients living outside major centres.

Acute acalculous cholecystitis caused by Hepatitis C: A rare case report.

INTRODUCTION: Acute acalculous cholecystitis (AAC) is rarely encountered in clinical practice and has a high morbidity and mortality. AAC caused by viral hepatitis, with hepatitis A, B and EBV infections are rare, but well documented in the literature. Hepatitis C virus has not been reported as cause of AAC. This case report documents the first case of AAC associated with Acute Hepatitis C. PRESENTING CONCERNS: We present a 40 years old female with abdominal pain. She has a history of previous HCV infection. Her liver function tests were markedly deranged with elevated inflammatory markers. USS scan showed rather a very unusual appearance of an inflamed gallbladder with no gallstones and associated acute hepatitis, confirmed by an abdominal CT scan. HCV RNA PCR confirms flair up of the virus. The patient was managed conservatively in the hospital with follow up USS scan and Liver function tests showed complete recovery. Follow up HCV RNA PCR also returned to an undetectable level. The patient recovered completely with no adverse outcomes. CONCLUSION: This case report is to the first to document the association between acute HCV and AAC. Despite being uncommon in western countries, viral hepatitis should be suspected as a causative agent of AAC, particularly when there is abnormal liver function test and no biliary obstruction.

Using quality-of-life instruments to measure outcome after laparoscopic fundoplication.

AIM: This article describe the symptomatic outcome of antireflux surgery in 56 consecutive patients in a single-centre, single-surgeon study--measured by previously validated, generic, and disease-specific quality-of-life instruments. METHODS: In this retrospective study, data was collected from the case records of patients and postal questionnaires. The quality-of-life instruments used were the global quality of life (GQOL) scale; gastroesophageal reflux disease health related quality of life (GERD-HRQL) scale; and the gastrointestinal symptom rating score (GSRS), self-administered version. Paired student t test and Wilcoxon signed rank test were used to analyse the data. RESULTS: The response rate to our postal questionnaire was 100%. The male:female ratio was 1:1.4 and the age range was from 19 to 71 years. The operative technique was either a 'total 360 degree wrap' (47 patients) or a partial posterior fundoplication (270 degree wrap) based on the DeMeester technique. The median follow-up time was 36 months. The mean hospital stay post procedure was 2.3 days. Our results showed good satisfaction rates (80%) and recommendation rates (93%). Best results were achieved in the subgroup of older (over 50 years of age) males. The side-effect profile was comparable to that reported in literature.