ORCID Profile
0000-0003-4534-2795
Current Organisation
St John of God Subiaco Hospital
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Publisher: Wiley
Date: 06-06-2023
DOI: 10.1111/ANS.18550
Abstract: This systematic review and meta‐analysis seeks to assess the modified protocols used and patient outcomes when enhanced recovery after surgery (ERAS) protocols are utilized in an emergency setting. PubMed, MEDLINE, EMBASE and Cochrane Central Registry of Controlled Trials were comprehensively searched until 13 March 2023. The Cochrane Risk of Bias Assessment Tool was used to assess for bias, along with funnel plot asymmetry. We present log risk ratios for dichotomous variables and raw mean differences for continuous variables. Seven randomized trials were included, comprising 573 patients. Results of the primary outcomes when comparing ERAS to standard care are as follows withdrawal of nasogastric tube (raw mean difference −1.87 CI: −2.386 to −1.359), time to first liquid diet (raw mean difference −2.56 CI: −3.435 to −1.669), time to first solid diet (raw mean difference −2.35 CI: −2.933 to −1.76), time to first flatus (raw mean difference −2.73 CI: −5.726 to 0.257), time to first stool passed (raw mean difference −1.83 CI: −2.307 to −1.349), time to removal of drains (raw mean difference −3.23 CI: −3.609 to −2.852), time to removal of urinary catheter (raw mean difference −1.57 CI: −3.472 to 0.334), mean pain score (raw mean difference −1.79 CI: −2.222 to −1.351) and length of hospital stay (raw mean difference −3.16 CI: −3.688 to −2.63). The adoption of ERAS protocols in an emergency surgery setting was observed to enhance patient recovery, while not indicating any statistically significant increase in adverse outcomes.
Publisher: Cardiofront, LLC
Date: 07-2022
Publisher: Springer Science and Business Media LLC
Date: 31-08-2023
DOI: 10.1007/S10029-023-02859-Z
Abstract: Cytoreductive surgery (CRS) is often combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal tumour deposits. Considering CRS, the evidence relating the large incisions, local chemotherapy and abdominal wall trauma to incisional hernias (IH) has not been synthesized. This systematic review and meta-analysis was conducted to examine the proportion of IH present in patients post CRS and the effect HIPEC had on these rates. PubMed, EMBASE, and Cochrane Central Registry of Trials were searched up to June 2023 to examine studies relating IH and CRS plus or minus HIPEC. The most up to date PRISMA guidelines were followed. Pertinent clinical information was synthesized in tabular form. A meta-analysis reporting the pooled proportions of IH post CRS plus or minus HIPEC, the odds of IH in HIPEC versus non-HIPEC CRS and the difference in follow-up time between groups was conducted. Nine studies comprising 1416 patients were included. The pooled proportion of IH post CRS was 12% (95% confidence interval (CI) 8–16%) in HIPEC and 7% (95% CI 4–10%) in non-HIPEC patients and 11% (95% CI 7–14%) overall. Previously reported rates of IH in midline laparotomy range from 10 to 30%. The odds of IH in the HIPEC was 1.9 times higher compared to non-HIPEC cohorts however this was not statistically significant (odds ratio (OR) 1.9, 95% 0.7–5.2 p = 0.21). There was no significant difference in average follow-up times between HIPEC and non-HIPEC cohorts. IH post CRS plus or minus HIPEC were in the expected range for midline laparotomies. IH in patients receiving HIPEC may occur at a greater proportion than in non-HIPEC patients, however, there were too few studies in our meta-analysis to determine this with statistical significance.
Publisher: Oxford University Press (OUP)
Date: 08-2023
DOI: 10.1093/JSCR/RJAD438
Abstract: Caecal varices are extremely rare with poorly defined management due to paucity of data. A 52-year-old man was diagnosed with a 3-day history of melena with a background of chronic liver disease and non-steroidal anti-inflammatory use. Investigations revealed anaemia with haemoglobin of 62 g/L, liver function derangement (Gamma-glutamyl transferase 251 U/L, alanine transaminase 40 U/L, bilirubin 84 umol/L, alkaline phosphatase 85 U/L), coagulopathy (International Normalized Ratio 1.6) and acute kidney injury (Creatinine 285 umol/L). Gastroscopy demonstrated no signs of upper gastrointestinal bleeding or portal hypertension. A large volume haematochezia occurred necessitating resuscitation with massive transfusion protocol, and colonoscopy was abandoned in favour of computerized tomography (CT) angiography, which revealed a large varix feeding the caecum. Urgent laparotomy and a right hemicolectomy was performed with application of abdominal vacuum dressing. The hemicolectomy s le was opened on back table demonstrating large caecal varix causing intraluminal bleeding. The patient was stabilized in intensive care, and a further laparotomy was performed 2 days later where an end ileostomy was formed. Caecal varices have been reported in literature with management via trans-jugular intrahepatic portosystemic shunt, endoscopically or conservatively with beta-blockade. Here we present, to the best of the author’s knowledge, the first reported case of successful surgical management of caecal varices.
Publisher: Wiley
Date: 13-08-2023
Abstract: Anal squamous cell carcinoma (ASCC) has a generally acceptable outlook in terms of survival. 18‐fluorodeoxyglucose‐positron emission tomography/computer tomography (FDG PET‐CT) is not recommended for routine monitoring post‐ASCC treatment. We examine herein if FDG PET‐CT has a use in the prognostic evaluation of patients with ASCC, what FDG PET‐CT metrics are of value and if a pre‐ or post‐chemo/radiotherapy scan is more prognostic of outcomes. PubMed, EMBASE and Cochrane Central Registry of Controlled Trials were comprehensively searched until 3 May, 2023. A modified Newcastle Ottawa scale was used to assess for study bias. We present our systematic review alongside pooled hazard ratios (HR) for maximum standardised uptake values (SUV) as a predictor of overall survival (OS) and progression‐free survival (PFS). Seven studies including 523 patients were included in our systematic review. Current evidence suggests that SUV maximum and median, metabolic tumour volume, total lesion glycolysis and complete and partial metabolic response may be prognostic when considering overall or progression‐free survival (OS)/(PFS) along with local recurrence (LR). Pooled HR from two included studies indicate SUV max is prognostic of OS, HR 1.179, CI (1.039–1.338), P = 0.011 and PFS 1.176, CI (1.076–1.285), P 0.01. FDG PET‐CT may have a role to play in the prognostic evaluation of ASCC patients. Current evidence suggests post‐treatment scanning may hold superior prognostic value at this time.
Publisher: MDPI AG
Date: 19-06-2021
DOI: 10.3390/JCM10122711
Abstract: Pancreatic ductal adenocarcinoma (PDAC) is the most common form of pancreatic cancer and carries a dismal prognosis. Resectable patients are treated predominantly with surgery while borderline resectable patients may receive neoadjuvant treatment (NAT) to downstage their disease prior to possible resection. PDAC tissue is stiffer than healthy pancreas, and tissue stiffness is associated with cancer progression. Another feature of PDAC is increased tissue heterogeneity. We postulate that tumour stiffness and heterogeneity may be used alongside currently employed diagnostics to better predict prognosis and response to treatment. In this review we summarise the biomechanical changes observed in PDAC, explore the factors behind these changes and describe the clinical consequences. We identify methods available for assessing PDAC biomechanics ex vivo and in vivo, outlining the relative merits of each. Finally, we discuss the potential use of radiological imaging for prognostic use.
Publisher: Springer Science and Business Media LLC
Date: 15-09-2023
Publisher: Wiley
Date: 16-09-2023
DOI: 10.1111/BJU.16170
Publisher: Cardiofront, LLC
Date: 11-2020
DOI: 10.4022/JAFIB.2415
No related grants have been discovered for Benjamin Mac Curtain.