The Ulster medical journal最新文献

Metastatic tumours to the pancreas are rare but most commonly arise from primary renal cell carcinoma (RCC). Contrary to other metastatic malignancies, metastatic RCC demonstrates indolent behaviour; with a long latency between primary tumour presentation and the development of metastasis, as well as a predilection to isolated pancreas-only disease. As such, pancreatic metastasectomy has evolved as a treatment option for patients with metastatic RCC; reported to associate with improved outcomes in selected patients. The aim of this study was to describe the clinicopathological characteristics and patient outcomes in a series of patients undergoing pancreatic resection for metastatic RCC in a high volume, regional hepatopancreatobiliary (HPB) centre.

Design: Retrospective review of all patients who underwent pancreatic metastasectomy for pathologically-confirmed metastatic RCC over an eighteen-year period. Clinicopathological characteristics and outcomes were collected and analysed.

Results: Fifteen patients underwent pancreatic resection for metastatic RCC between October 2004 and October 2022. Two patients underwent synchronous nephrectomy and pancreatectomy. In thirteen patients, the pancreas was the only site of metastatic disease. For those with metachronous metastases, the median disease-free interval (DFI) was 126 months from initial nephrectomy.Five-year disease-free and overall survival were 32.7 % and 63.3 %, respectively. No clinicopathological factor was found to associate with overall survival (OS); however, patients with synchronous metastatic disease had a significantly shorter disease-free survival (p = 0.029). Similarly, patients with a longer DFI (≥ ten years) between RCC primary and the development of pancreatic metastases had a trend towards improved OS (p = 0.074).Post-operative morbidity and mortality rates were comparable to that of pancreatic surgery for primary pancreatic pathology.

Conclusion: This case series supports the role of pancreatic resection in patients with metastatic RCC, with acceptable rates of morbidity and mortality and favourable patient outcomes. The long DFI between nephrectomy and pancreatic metastases highlights the importance of long-term follow-up for patients diagnosed with RCC.

Introduction: Total hip arthroplasty (THA) for displaced intracapsular hip fracture is increasingly common. The aim of this project was to determine all-cause mortality rates, rates of significant complications and functional outcomes following THA for fractures.

Methods: An inpatient database search identified all patients undergoing THA for displaced intracapsular fracture in Northern Ireland's regional trauma centre from 2010-2017. Regional electronic healthcare systems were reviewed for evidence of complications.

Results: After exclusions, 345 cases were identified. The median age was 70 years (31 - 91 years).Median follow-up was 4.3 years (1.6 - 9.3 years). The all-cause mortality rate was 0.3% at 30 days, 3.2% at one year, and 5.5% at two years.Seven patients (2.0%) experienced dislocations. Most occurred within 60 days; five patients underwent revision.Radiographic evidence of heterotopic ossification (HO) was seen in 48 patients (13.8%).Re-operation was required for 16 patients (4.6%). This included 5 dislocations, eight cases of periprosthetic fractures (in seven patients), two cases of infection, and one case of symptomatic HO.Pre-injury, 96.2% (332/345) were independently mobile, and after one year 78.9% (262/332) of those patients remained so. Pre-injury, 96.2% obtained the maximum functional score (Barthel Index, maximum score of 20), and after one year 78.9% (262/332) of these continued to report a maximum Barthel Index score.

Conclusion: THA for hip fracture holds a 2.0% risk of dislocation and a 4.6% risk of re-operation. HO is common but seldom requires re-operation. All-cause mortality rates and functional levels compared favourably with current literature.

Discussion of bioethical issues using the four principles approach proposed by Beauchamp and Childress is now standard practice in the UK. This paper first documents the history of principlism before considering its impact and reviewing some criticisms of the approach. A future paper will examine some of the philosophical difficulties arising from principlism in greater depth.