Hyperamylasaemia in ureteric colic.

Hyperamylasaemia is classically associated with acute pancreatitis. Hyperamylasaemia may be associated with many other clinical conditions. However, ureteric colic has never been reported to cause hyperamylasaemia. We describe a 47-year-old woman who presented with an atypical history of left ureteric colic. Radiological investigations confirmed an upper ureteric stone with urinary extravasation. At presentation, the serum amylase was elevated but normalised after 24 h. In conclusion, ureteric colic may cause hyperamylasaemia and this is likely a result of pancreatic irritation due to urinary extravasation. Patients presenting with ureteric colic and elevated concentrations of serum amylase should raise the clinical suspicion of urinary extravasation.

Variation in the use of postoperative radiotherapy among high-risk patients following radical prostatectomy.

BACKGROUND: We used data from the Michigan Urological Surgery Improvement Collaborative (MUSIC) to investigate the use of adjuvant and salvage radiotherapy (ART, SRT) among patients with high-risk pathology following radical prostatectomy (RP). METHODS: For patients with pT3a disease or higher and/or positive surgical margins, we examined post-RP radiotherapy administration across MUSIC practices. We excluded patients with <6 months follow-up, and those that failed to achieve a postoperative PSA nadir ⩽0.1. ART was defined as radiation administered within 1 year post RP, with all post-nadir PSA levels <0.1 ng ml(-1). Radiation administered >1 year post RP and/or after a post-nadir PSA ⩾0.1 ng ml(-1) was defined as SRT. We used claims data to externally validate radiation administration. RESULTS: Among 2337 patients undergoing RP, 668 (28.6%) were at high risk of recurrence. Of these, 52 (7.8%) received ART and 56 (8.4%) underwent SRT. Patients receiving ART were younger (P=0.027), more likely to have a greater surgical Gleason sum (P=0.009), higher pathologic stage (P<0.001) and received treatment at the smallest and largest size practices (P=0.011). Utilization of both ART and SRT varied widely across MUSIC practices (P<0.001 and P=0.046, respectively), but practice-level rates of ART and SRT administration were positively correlated (P=0.003) with lower ART practices also utilizing SRT less frequently. Of the 88 patients not receiving ART and experiencing a PSA recurrence ⩾0.2 ng ml(-1), 38 (43.2%) progressed to a PSA ⩾0.5 ng ml(-1) and 20 (22.7%) to a PSA ⩾1.0 ng ml(-1) without receiving prior SRT. There was excellent concordance between registry and claims data κ=0.98 (95% CI: 0.94-1.0). CONCLUSIONS: Utilization of ART and SRT is infrequent and variable across urology practices in Michigan. Although early SRT is an alternative to ART, it is not consistently utilized in the setting of post-RP biochemical recurrence. Quality improvement initiatives focused on current postoperative radiotherapy administration guidelines may yield significant gains for this high-risk population.

Transient femoral nerve palsy following ilio-inguinal nerve blockade for day case inguinal hernia repair.

BACKGROUND: Transient femoral nerve palsy (TFNP) has been reported in patients undergoing inguinal hernia repair involving the use of ilio-inguinal nerve block. Ilio-inguinal nerve blocks can be administered under vision by the surgeon or by the anaesthetist using a standard blind technique. There has been no study that has specifically examined the incidence of this complication and whether its development is related to the type of method used to administer the block. PATIENTS AND METHODS: Data on patients undergoing surgery in the Royal Infirmary Edinburgh Day Case Unit are collected prospectively. All patients who undergo inguinal hernia repair are given ilio-inguinal field blocks, either pre-operatively by anaesthetists (blind technique) or peri-operatively under direct vision by surgeons. Several cases of TFNP were initially identified during the process of surgical audit and this led to a retrospective analysis over a period of one year. RESULTS: During a 12-month period, 194 patients underwent 200 open inguinal hernia repairs (188 unilateral and 6 bilateral), under general anaesthesia. Ten patients (5%) developed TFNP resulting in overnight admission. Surgeons administered 101 blocks under direct vision of which 4 (4%) resulted in TFNP, whereas 6 out of 99 (6%) blind blocks resulted in TFNP (p=0.49, df=1, Chi2 test). DISCUSSION AND CONCLUSION: TFNP is a recognised complication following ilioinguinal nerve blockade for inguinal hernia surgery. Our series shows that ilio-inguinal block given under direct vision does not appear to reduce the chance of this complication occurring. This may result from the fact that this complication could be due to local infiltration into the operative field rather than direct infiltration around the femoral nerve. As inguinal hernia repair undertaken as a day case procedure increases, the awareness of this complication is important to avoid morbidity