Colonic self-expanding metal stents (SEMS) in acute large bowel obstruction
Colonic self-expanding metal stents are increasing used in the management of acute large bowel obstruction, both as a bridge to surgery and as a definitive palliative measure in patients unfit for surgery. We describe our experience from a New Zealand hospital and compare our data with that already published in literature. Our technical and clinical success rates were 90% and 88% respectively. The procedure was palliative in 15 patients and as a bridge to elective surgery in 13 cases. Procedure-related mortality was 7%. It was because of one early and one late perforation. The average length of stay post procedure was 2 days. Mean survival post stent insertion in the palliative group was 2.4 months and for those with a bridge to surgery was 14 months. Conclusion Our results support the data published from international centres in terms of deployment of SEMS in patients with acute large bowel obstruction, both as a bridge to surgery and as a definitive palliative measure.
Review of 100 consecutive microvascular free flaps
Free flap surgery is an integral part of modern day plastic surgery. The operation involves the transfer of tissue, along with its blood supply from the original (donor) location to another (recipient) location. Free flaps are extremely versatile and they can be performed for a variety of reasons including reconstructing a breast following breast cancer surgery; coverage of a defect following tumour resections from the head and neck region and coverage of exposed bones following repair of fractures. After decades of refinement of surgical techniques and improved perioperative management, success rates of more than 90% have widely been reported in the international literature. This study showed that free flap reconstructions in our regional plastics and reconstruction centre have an excellent success rate (96%); and the results are comparable to international literature.
Outcomes of patients with untreated severe aortic stenosis in real-world practice
Aortic stenosis once symptomatic can be debilitating and deadly. We attempted to assess the burden of this disease in New Zealand using Waikato Hospital as a reference centre. We found about half our patients referred for surgical aortic valve replacement are declined surgery. During our follow-up (34 months) 73% of patients were dead who were declined from surgery compared to 18% of operated patients. Also the surgically declined patients were significantly debilitated with symptoms leading to poor quality of life and required more hospital stay utilising the health dollar.
Emergency peripartum hysterectomy: a 10-year review in a tertiary obstetric hospital
According to the World Health Organization (WHO) postpartum haemorrhage (bleeding after a woman has just given birth) accounts for one-quarter of maternal deaths worldwide. There are occasions when an emergency peripartum hysterectomy (EPH) is necessary to remove the uterus, in order to control these haemorrhages. Although it is a life-saving procedure, this study found that EPH is itself associated with considerable maternal morbidity. This study also found that the most common indication for an EPH is abnormal placental implantation where the placenta is too close to the cervix or goes through the uterus lining, as a result of a previous caesarean delivery. It is hoped that this study will alert medical practitioners to this indication so that they will be more vigilant about the placental implantation in women with previous caesareans antenatally e.g. scans to determine placental site, and the medical team and woman can prepare and plan ahead of the delivery if this problem arises.
Temporal trends and clinical characteristics of spontaneous intracerebral haemorrhage in the Waikato region of New Zealand: a hospital-based analysis
This study investigated intracerebral haemorrhage (ICH) or sudden bleeding within the brain detected in the hospitals of the Waikato region of New Zealand between 1999 and 2008. 653 episodes of ICH were identified. Observed ICH has increased in incidence in our hospitals over the past 10 years. Increasing availability of neuroimaging, increasing numbers of elderly, and increasing warfarin (a blood thinner used in heart conditions)-associated ICH were likely contributors to this observed increase. Radiological evidence of extension of intraventricular bleed, warfarin use, lobar location of bleed, and increasing age correlated with poorer survival. This data will be available for comparison with future studies to assess trends in incidence, patient characteristics and outcome in ICH.
Secondary prevention of vertebral fractures in a large New Zealand District Health Board
Osteoporosis is a common medical condition affecting many New Zealand older adults. Vertebral fractures are a common manifestation of osteoporosis and strongly predict future fractures. Medications proven to help prevent further fractures are available, yet this audit shows many patients with prior fractures presenting to Waitemata District Health Board were not adequately treated. This appeared particularly so for men with prior fractures.