Ian P. Hayes

Effect of the introduction of an emergency general surgery service on outcomes from appendicectomy

Appendicectomy is a common general surgical emergency procedure and may be used as a surrogate marker to evaluate quality in surgical management. The aim of this study was to assess the outcomes of appendicectomy before and after the introduction of a consultant‐led emergency general surgery (EGS) service at a large metropolitan tertiary referral centre.

Operative intervention rates for acute diverticulitis: a multicentre state‐wide study

Acute colonic diverticulitis is placing an increasing strain on our health care resources. Measurement of the problem is difficult at a regional level, yet essential to improve and optimize treatment of this condition. Therefore, we aimed to use Australian state‐level administrative data to determine the current practice and outcomes in major metropolitan hospitals.

Comparing oncological outcomes of laparoscopic versus open surgery for colon cancer: Analysis of a large prospective clinical database.

Oncological outcomes of laparoscopic colon cancer surgery have been shown to be equivalent to those of open surgery, but only in the setting of randomized controlled trials on highly selected patients. The aim of this study is to investigate whether this finding is generalizable to real world practice.

Kohlschütter–Tönz Syndrome: Mutations in ROGDI and Evidence of Genetic Heterogeneity

Kohlschütter–Tönz syndrome (KTS) is a rare autosomal recessive disorder characterized by amelogenesis imperfecta, psychomotor delay or regression and seizures starting early in childhood. KTS was established as a distinct clinical entity after the first report by Kohlschütter in 1974, and to date, only a total of 20 pedigrees have been reported. The genetic etiology of KTS remained elusive until recently when mutations in ROGDI were independently identified in three unrelated families and in five likely related Druze families. Herein, we report a clinical and genetic study of 10 KTS families. By using a combination of whole exome sequencing, linkage analysis, and Sanger sequencing, we identify novel homozygous or compound heterozygous ROGDI mutations in five families, all presenting with a typical KTS phenotype. The other families, mostly presenting with additional atypical features, were negative for ROGDI mutations, suggesting genetic heterogeneity of atypical forms of the disease.

Does the haemodynamic response to acute central hypovolaemia depend on the rate of fall of cardiac output

1. In published studies of the effects of acute blood loss in conscious rabbits, the rates of haemorrhage have ranged for 3–9% of blood volume/min. This is potentially a confounding factor when it comes to comparing the results of different studies. We have therefore tested whether the haemodynamic response to acute central hypovolaemia depends on the rate of fall of cardiac output.

Outcomes in emergency general surgery following the introduction of a consultant-led unit.

Patients presenting with emergency surgical conditions place significant demands on healthcare services globally. The need to improve emergency surgical care has led to establishment of consultant‐led emergency surgery units. The aim of this study was to determine the effect of a changed model of service on outcomes.

Effects of α-adrenoceptor antagonists and clonidine on the haemodynamic response to acute hypovolaemia in conscious rabbits

In conscious rabbits an inferior vena caval cuff was progressively inflated so cardiac output fell at a constant approximately 8% of its baseline value. There was a biphasic haemodynamic response, consisting of an initial compensatory phase during which there was progressive systemic vasoconstriction and tachycardia, followed by a decompensatory phase in which systemic vasoconstriction failed abruptly, blood pressure plummeted and heart rate declined. We tested the effects on the haemodynamic response of prior 4th ventricular, and in some cases intravenous, infusions of saline, yohimbine, clonidine, yohimbine plus clonidine, and bunazosin. From the results we conclude that a yohimbine-sensitive mechanism in the brainstem, possibly alpha 2-adrenoceptor-mediated, may be an essential element of the cardiac receptor-mediated decompensatory phase of acute central hypovolaemia, but does not contribute to the arterial baroreflex-mediated compensatory phase.

Intracranial metastasis from carcinoma of the paranasal sinus.

Carcinomas of the paranasal sinuses are locally invasive tumors that only occasionally metastasize. The tumor may spread intracranially by local invasion through the dura into the frontal lobes and extension along the vidian nerve. We describe two cases of cerebellar metastasis in patients with local recurrence and discuss the mechanism of spreading. It is possible that more aggressive treatment of these tumors, which results in longer survival, may be associated with an increased incidence of intracranial metastasis.

Impact of anastomotic leak on recurrence and survival after colorectal cancer surgery: a BioGrid Australia analysis.

There is conflicting evidence regarding the oncological impact of anastomotic leak following colorectal cancer surgery. This study aims to test the hypothesis that anastomotic leak is independently associated with local recurrence and overall and cancer‐specific survival.

Gunsight skin incision and closure technique for stoma reversal.

BACKGROUND: Several techniques have been described in the literature for skin closure following stoma reversal. We describe the “gunsight skin closure” technique and highlight its potential advantages. METHOD: Four triangles of skin are excised to enlarge the skin incision. This increases exposure for mobilization of the bowel. The resulting skin wound is approximated with a pursestring suture to give a small, neat scar that allows some central drainage. The final wound resembles a gunsight. CONCLUSION: This method of skin closure allows increased surgical exposure, facilitates creation of a subsequent stoma at the same site, simplifies wound care, and gives a neat cosmetic result.