Ned Kinnear

Implementation rates of uro-oncology multi-disciplinary meeting decisions

To assess implementation rates of the consensus plans made at the uro‐oncology multidisciplinary meeting (MDM) of an Australian tertiary centre, and analyse obstacles to implementation.

Atrial fibrillation and risk of hip fracture: A population-based analysis of 113,600 individuals

BACKGROUND A number of cardiovascular diseases have been linked with bone health and an increased risk of osteoporotic fracture. Whether atrial fibrillation (AF) is associated with subsequent fracture risk is not known. METHODS Administrative, clinical and hospitalisation information were linked over a 14-year period. From this longitudinal, population-based dataset of 113,600 individuals, time-dependent exposures using multivariate Cox proportional hazards regression models were employed to determine incidence rates and hazard ratios (HR) for hip fracture according to a history of AF. RESULTS The annualised incidence rate for hip fracture was 7.4 per 1000 person-years (95% CI 7.1-7.7) in those without AF and 17.5 per 1000 person-years (95% CI 16.8-18.1) in those with AF. Compared to individuals without AF, those with AF were more likely to develop incident hip fracture in both men (unadjusted HR 2.39 [95% CI 1.96-2.91]) and women (unadjusted HR 2.91 [95% CI 2.55-3.34]). After adjusting for potential confounders, these associations were attenuated but remained statistically significant (adjusted HR 1.97 [95% CI 1.61-2.42] in men; adjusted HR 2.08 [95% CI 1.80-2.39] in women). CONCLUSIONS A history of AF was associated with an increased risk of hip fracture in this large, population-based analysis. This association appeared to remain significant even after adjusting for potential confounders such as age, comorbidities and medication use. Patients with a history of AF may represent a clinical population in whom screening for and treatment of osteoporosis may be warranted to reduce the risk of subsequent fracture.

Tuberculous epididymo-orchitis masquerading as acute scrotum.

An 18-year-old boy, a refugee from Afghanistan, with no significant medical history, presented after 1 day of severe left testicular pain. History, clinical examination and scrotal ultrasound suggested the diagnosis of epididymo-orchitis. He was discharged on a 2-week course of amoxicillin/clavulanic acid. Six weeks later, he re-presented with a testicular abscess, continuous with the epididymal head. Incision and drainage led to laboratory confirmation of tuberculous infection. He was treated with isoniazid, rifampicin, ethambutol, pyrazinamide and vitamin B6 for 9 months, with good response. Despite meeting high-risk criteria for tuberculosis, our patient had a delayed diagnosis. We present the case and discuss the lessons learned.

Impact of an acute surgical unit on patient outcomes in South Australia

Compared with traditional (Trad) systems of managing emergency surgical presentations, the acute surgical unit (ASU) model provides an on‐site registrar, on‐call surgeon and dedicated emergency theatre, 24 h/day. To date, there have been no Australasian ASU studies of >3000 patients, nor from South Australia.

The impact of intra-operative cell salvage during open radical prostatectomy

Background To examine the effect of intra-operative cell salvage (ICS) in open radical prostatectomy. Methods In this retrospective cohort study, all patients undergoing open radical prostatectomy for malignancy at our institution between 10/04/2013 and 10/04/2017 were enrolled. Patients were grouped and compared based on whether they received ICS. Primary outcomes were allogeneic transfusion rates, and disease recurrence. Secondary outcomes were complications and transfusion-related cost. Results Fifty-nine men were enrolled; 30 used no blood conservation technique, while 29 employed ICS. There were no significant differences between groups in age, pre- or post-operative haemoglobin, Charlson comorbidity index, operation duration or length of stay. Tumour characteristics were also similar between groups, including pre-operative prostate specific antigen, post-operative Gleason score, T-stage, nodal status and rates of margin positivity. Compared with controls, the ICS group had longer follow up (945 vs. 989 days; P=0.0016). The control and ICS groups were not significantly different in rates of tumour recurrence (6 vs. 3 patients; P=0.30) or complications (10 vs. 5 patients; P=0.16). While the proportion of patients receiving allogenic transfusion was similar (9 vs. 6 patients; P=0.41), fewer red blood products transfused (40 vs. 12 units) meant transfusion related costs were lower in ICS patients (AUD

Intermittent superior mesenteric artery syndrome in a patient with multiple sclerosis

47,666 vs.

Surgical management of chronic genital lymphoedema

37,429). Conclusions ICS reduced transfusion related costs, without affecting allogeneic transfusion rates, tumour recurrence or complication rates. These findings extend the literature supporting ICS in oncological surgery. Prospective randomised studies are needed to confirm the existing level III evidence.

Intra-operative cell salvage in urological surgery: a systematic review and meta-analysis of comparative studies

A 42-year-old man with multiple sclerosis presented with recurrent vomiting, in the context of recent weight loss. Computed tomography scan of the abdomen and pelvis revealed duodenal compression by the superior mesenteric artery (SMA), consistent with intermittent SMA syndrome. Subsequent gastroscopy and barium meal follow-through showed resolution of the obstruction. SMA syndrome is rare and has not previously been reported in a patient with multiple sclerosis. We hypothesize that loss of the aortomesenteric fat pad on the background of contorted body habitus from multiple sclerosis placed the patient at risk for intermittent positional compression of his duodenum.

The impact of intra-operative cell salvage during open nephrectomy

A 44-year-old man with a spinal cord injury was referred to a specialist urology service with a 7-year history of significant genital swelling. His condition had eluded diagnosis and was refractory to all previous treatments. The considerable swelling both impacted his quality of life and prevented the patient from adequately managing his neurogenic bladder. He was diagnosed with chronic idiopathic genital lymphoedema and underwent total scrotectomy, wide penile skin excision and split skin graft to the penile shaft. The patient made an excellent recovery. We present this unusual case with preoperative, intraoperative and postoperative images.

Impact of an acute surgical unit on outcomes in acute cholecystitis: Impact of an ASU in cholecystitis

To evaluate systematically the safety and efficacy of intra‐operative cell salvage (ICS) in urology.