Scottish Medical Journal最新文献

Background: Emergency appendicectomy (EA) is a common procedure, yet few studies have focused on gender differences in these patients. This study aims to evaluate the demographics, preoperative investigations, intraoperative findings, and clinical outcomes between males and females undergoing EA.

Methods: A multicenter retrospective observational study was conducted across four hospitals involving patients who underwent EA between August 2018 and November 2025. Patients were identified through pathology records, and data were collected on demographics, preoperative blood tests, imaging, operative details, and clinical outcomes and results compared.

Results: 1128 patients were included, with 57.5% being male. Males were younger (median age: 34 vs 40 years, P < .001). There was no significant difference in preoperative white cell or neutrophil counts, although males had lower C-reactive protein levels (median 72 vs 97, P < .001). Females were more likely to undergo pre-operative imaging, including ultrasound (20.7% vs 1.5%, P < .001) and CT scans (61.8% vs 54.9%, P = .020). Open surgery was more common in males (14% vs 6.5%, P < .001). No differences were observed in the severity of appendicitis, negative EA rates, hospital stay duration, postoperative complications, or 30-day readmission rates.

Conclusions: Although differences exist between genders in terms of age, imaging usage, and surgical approach, clinical outcomes are comparable.

Background and aims: Routine group and save (G&S) is commonly performed before appendicectomy despite limited evidence. This study aims to evaluate the necessity of preoperative G&S by determining perioperative blood transfusion rates.

Methods: A multicentre retrospective observational study of adult patients who had emergency appendicectomy across four hospitals between August 2018 and November 2020. Data analysed included demographics, operative details, G&S, crossmatching and perioperative blood transfusion.

Results: 1105 patients were identified, 635 (57.4%) were male. Median age was 37 years (IQR 26-52). 1012 (91.6%) were ASA 1 or 2. Surgical approach: 890 (80.5%) laparoscopic, 79 (7.1%) converted to open, 119 (10.8%) open and 17 (1.5%) laparotomy. Severity of appendicitis: 804 (72.8%) inflamed, 56 (5.1%) gangrenous, 235 (21.3%) perforated and 10 (0.9%) normal. 921 (83.3%) patients had preoperative G&S. 42 (3.8%) patients also had crossmatch. No patients required blood transfusion in 30 days post appendicectomy. The cost of G&S is estimated to be £40,164 in this cohort.

Conclusions: The need for perioperative blood transfusion is rare in patients undergoing appendicectomy. It has a significant cost impact and can cause unnecessary delays. Our study suggests that a routine G&S policy is not necessary, and we suggest a more 'selective' G&S policy.

Background: Insulinomas are rare endocrine tumors of the pancreas. The majority are benign, sporadic, and solitary. Surgery is the only curative treatment. In this study, we present our experiences with the perioperative management of sporadic and benign pancreatic insulinomas.

Methods: Patients who underwent surgery for pancreatic insulinoma in our clinic between 2008 and 2023 were retrospectively reviewed. Demographic data, preferred radiological methods, surgical procedures, and morbidity and mortality data were evaluated. Patients with malignant, invasive, or familial multiple endocrine neoplasia mutations were excluded from the study.

Results: Nineteen patients underwent surgery, with a median age of 49 years (range: 33-85). Symptoms related to hypoglycemia were the most commonly observed. The tumor location was identified preoperatively in 74% of cases using computed tomography. Palpation and intraoperative ultrasound identified the tumor location in 88% of patients. Enucleation (53%) were the most common surgical procedures. Pancreatic fistula occurred in three patients (17%). While serious morbidity was lower in patients who underwent enucleation, the rate of fistula formation was higher.

Conclusion: The accurate localization of insulinomas plays a crucial role in determining the appropriate surgical procedure. With high success rates and lower morbidity, enucleation is the recommended procedure for suitable patients.

Background and aims: The Scottish Highlands face unique prehospital care challenges due to population dispersity, mountainous terrain, seasonal weather, and higher trauma burden compared to the nearest Major Trauma Centres (MTCs) as highlighted by the Scottish Trauma Audit Group (STAG). Primary road/air transfer from scene to nearest designated MTC averages 1-5 hours, making prompt and informed utilisation of prehospital and in-hospital resources within the Highlands critical - comparative to other UK metropolitan regions where the trauma population majority lay within 20-45 minute transfer windows. This paper reviews the Highland pre-hospital immediate care and trauma (PICT) Team's trauma response through a retrospective review of PICT patient report forms (PRFs).

Methods and results: The analysis highlighted increased trauma response by the team in the nature of attended callouts and interventions utilised. Improving trends of patient outcomes, increased advanced analgesia and medico-surgical intervention utilisation, and relative increase of road traffic collision attendance and trauma-specific calls were noted.

Conclusion: Results highlight the Scottish Highlands' trauma burden and PICT's added value; with increased trauma response and improving outcomes. Despite the rate and ratio of major trauma not reducing PICT Team utilisation has, potentially led to fewer patients over narrower geography at later stages in emergency calls accessing the enhanced care doctor and advanced physician team than was achieved previously.

Background and aims: To assess the present state of robotic surgery and the surgical approaches employed by urology departments utilizing robotic systems in Spain.

Methods and results: An email invitation was sent to heads of urology departments in public and private hospitals with surgical robots. A 78-question online questionnaire was distributed, and data were collected over 3 months. Of 82 invitations, 57.31% responded, mostly male (95.7%) urologists over 50 years old, with 77.8% having more than 20 years of practice. About 45.7% worked in both public and private settings. Most units use robots 1-3 days per week, with 56.1% of these units having 1-3 surgeons trained. 92.3% of respondents had laparoscopic experience, and 71.1% received robotic surgery training from the robot company. Radical prostatectomy, pyeloplasty, and cystectomy are mainly performed robotically, while other surgeries vary in approach.

Conclusion: Robotic surgery has been firmly established in Spain, although the percentage of surgeries in robotic units remains low. Radical prostatectomy, pyeloplasty, and radical cystectomy with diversion are the most commonly performed techniques using robotic approaches.

Background: This study primarily aims to compare the influence of core stabilization exercise and conventional therapy on motor function, functional independence, and balance, secondarily gait ability, quality of life, and sonographically evaluated core muscle thickness in patients with chronic stroke.

Methods: Participants were randomly allocated into two groups: core stabilization exercise therapy (CSET, n = 25) group received core stability training for 15 min and 30 min of conventional therapy each per day, and conventional exercise therapy (CET, n = 25) group received conventional therapy for 45 min per day, five days per week, for three weeks. Ultrasonography was performed to measure the thickness of the core muscles on both paretic and nonparetic sides. Patients were evaluated at baseline and after three weeks treatment.

Results: Functional Independence Measurement, Berg Balance Scale, 6-Minute Walk Test, Stroke-Specific Quality of Life Scale and core muscles thicknesses improved significantly in both groups except for the internal oblique muscle of CSET group. The nonparetic side multifidus muscle thickness was significantly different in favor of CSET group (p = .033).

Conclusions: Conventional and core stabilization exercise therapies in patients with chronic stroke have positive effects on functional independence, balance and gait abilities, quality of life and core muscles thicknesses without being superior to each other.

Objectives: To assess the feasibility of performance enhancement coaching (PEC) for newly appointed Urology registrars (ST3s), specifically: whether the concept appealed, and which areas beyond technical skills acquisition were felt to be most relevant or useful.

Subjects and methods: All delegates on the Urology Bootcamp 2023 were invited to take part in an online survey before and after a 2-hour PEC workshop, collecting: basic demographic data, performance challenges, and the important aspects to include in, and consider with, a coaching programme. The workshop was delivered by a surgeon with a professional coaching qualification, to groups of four delegates at a time over 4 days. Ten pre-defined areas were offered during the session.

Results: On a scale of 1 (poor) to 10 (excellent), the 62 participants' overall health was reported as a median of 8/10 (physical) and 7/10 (mental). Anxiety during performance was the most common concern (63%) and was accompanied by a tremor in 55%. The next most popular concerns, with 19% of responses each, were: sleep, insufficient operative skill or expertise, and worry about relationships with trainers. The commonest topics discussed were 'the inner critic' (100%), 'autonomic modulation' (69%), 'not working, well' (13%) and 'optimising study' (6%). Seventy-seven per cent were unaware of PEC for practising surgeons. All respondents felt that they would benefit from PEC to some extent (80% ≥8/10 where 10/10 was 'very useful'), ideally at the ST3 level. Sixty-two percent of respondents said there should be a fee for trainees, whereas 38% thought it should be free and paid for by their training authorities.

Conclusion: The concept of PEC is acceptable to ST3 Urology trainees, with particular interest in techniques to mitigate negative self-talk and autonomic modulation techniques. Existing barriers to coaching for the surgical community would need to be addressed in designing an acceptable coaching programme.

Objectives: To systematically synthesize existing reported literature calculating the carbon footprint (CFP) of urological surgical practice and identify opportunities for improving the environmental impact of urology surgical practice.

Methods: A systematic review was performed following PRISMA guidelines. The Cochrane, Embase, Ovid MEDLINE, and PubMed were searched between 1971 and 2023, with inclusion and exclusion criteria. The outcome measures were mapped across the included studies including assessment of risk of bias.

Results: A total of 345 studies with titles were identified from an initial search, however only 5 were included. Three studies compared singleuse with reusable cystoscopes concluded that single-use cystoscopes are non-inferior to reusable cystoscopes environmentally due to the carbon footprint associated with decontamination and repackaging. Similarly, in a single study, the CFP of single-use and reusable ureteroscopes is comparable. Lastly, a single study concluded that robotics-assisted surgery in prostate cancer may be a better option than other approaches in terms of environmental sustainability.

Conclusions: In conclusion, although minimally invasive (including robotic approaches) and endoscopic surgeries offer significant opportunities to improve healthcare we do need to consider the environmental impact. However, there is a paucity of good-quality literature to guide urological surgical practice to reduce the CFP and improve sustainability.