Scottish Medical Journal最新文献

BackgroundEmergency 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.MethodsA 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.Results1128 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.ConclusionsAlthough differences exist between genders in terms of age, imaging usage, and surgical approach, clinical outcomes are comparable.

Background and AimsRoutine 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.MethodsA 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.Results1105 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.ConclusionsThe 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.