A 59-year-old woman self presented to the emergency department with a painful right eye following a motor vehicle accident. She had reduced visual acuity and the eye had an alkaline pH with complete corneal uptake of fluorescein. Diagnosis of corneal abrasion and alkali burn to her right eye secondary to inflation of a driver's automobile airbag was made. The eye was irrigated with normal saline. Such injuries, although rare, can easily be identified within the emergency department by the history of exposure, evidence of facial injuries or burns, and an alkaline pH in the inferior culde-sac of the eye. Early detection and management with ophthalmology review is therefore imperative to prevent irreversible visual impairment.

The occurrence of conductive hearing loss after the surgical removal of an acoustic neuroma has not previously been documented. Computed tomographic scan of the temporal bones showing inner ear dehiscence may explain this finding. Formal documentation of such cases may allow techniques to be developed to reduce its occurrence or reconstruction of the defect at the time of primary surgery.

Introduction The advantages of robot-assisted pyeloplasties (RALP) have been widely documented and increasingly familiar. A 'learning curve' (LC) is difficult to define and its objective review remains problematic. We aimed to evaluate the LC, and outcomes, of RALP performed at our newly established robotic centre. Method and materials After the appropriate training, robot-assisted surgery (RAS) commenced at our centre. A prospective database was maintained regarding demographics and intra-operative timings of all cases, post-operative stay and complications. The data were statistically interrogated and linear regression analysis was performed. Results Between April 2014 and September 2018, 29 urological RAS were performed including 23 RALP. The total operating and total console times were significantly decreased over time, with no significant differences seen in length of stay or complication rates. Regression analysis predicted achievement of open pyeloplasty time (148 min) at 26 cases and 'expert' console time (58 min) by case 34. Median length of stay was 2 days and operative success rate 96%. Discussion RAS is proliferating across the globe. LC is difficult to define objectively. We suggest that the points described here in this 'learning journey' can be applied to other nascent departments and that RALP is safe and feasible within a developing urology unit.

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Historically, patients presenting with large, inoperable cancers were treated with radiation therapy alone or radiation therapy followed by surgical resection. The use of systemic therapy in patients with locally advanced breast cancer (LABC) has led to improved disease outcome when compared with surgery or radiotherapy alone. In comparison with operable breast cancer, there is a relative paucity of randomised trials evaluating systemic therapy for LABC. Of the randomised trials published, a statistically significant survival benefit is only demonstrated in a few. The difficulties in performing large randomised trials in LABC relate to several issues. The classification of LABC which includes T3, T4, and N2 disease incorporates a heterogeneous group of patients. There is a variable approach taken by clinicians in terms of the type of pre-operative chemotherapy used, sequencing of locoregional therapy and whether post-operative adjuvant systemic therapy is also given. To date, the efficacy of systemic therapy in LABC has largely been established from results of non-randomised Phase II studies. These studies compare favourably to historical data with higher 5-and 10-year disease-free and overall survival. A common finding in several trials of pre-operative systemic treatment is that the rates of breast conserving surgery is increased and those patient achieving a complete pathological response have superior disease outcomes than those who do not.An overview of trials supporting the current management of LABC will be presented. The objectives and preliminary findings of a multicentre study initiated in Perth for women with LABC will also be discussed. This paper explores the modern concept of Specialist Palliative Care. This includes the gradual and ongoing development of specialist palliative care services in New Zealand, embedded within cancer services and the wider health sector: within the community and the acute care environment. No longer is it accurate to assume that a referral to palliative care indicates that the person is imminently dying or that their care will be transferred to that service as an alternative to any form of continued active treatment. Cancer can be aggressive and unremitting but is increasingly experienced as a chronic illness and patients have concerns and needs that fluctuate over time. Multidisciplinary palliative care must be responsive, flexible and able to assist at "points of need", working together with the referring team. Collaboration across all the medical disciplines and the full health care team is essential and communication between services must be robust so that our care is consistent, unambiguous and patient-centred. Palliative care is as aspect of clinical care that we all practice, every day, sometimes without realising it. We need to continually develop our own skills in symptom control, effective communication and decision-making, as well as exploring the philosophy and ethics of end-of-life care. Accessible, meaningful education in all of these areas is vital. While ...