The chronic and relapsing nature of hidradenitis suppurativa leads to physical and psychological damage. The absence of a proven cure further worsens the scenario. Patient 1 was a 28-year-old woman with a 10-year history of abscesses and non healing sinuses with foul-smelling discharge from her axilla, submammary and groin areas. This led to an episode of self-harm due to severe depression. After failed medical therapy, she was referred for surgery with wide excision of the skin and healing by secondary intention. Her wounds were managed by our specialist wound clinic with the use of topical and systemic antibiotics and thus remained free from symptoms. Patient 2 was a 32-year-old woman with a similar history for 15 years. Patient 3 was a 41-year-old man with a 20-year history of discharging sinuses and abscesses. All the patients had endured a long period of medical treatment and subsequently required surgery for a long-term relief of symptoms. This has undoubtedly led to psychological symptoms and a decrease in quality of life.

CRM involvement is an important predictor of poor prognosis. CAP criteria differentiate a higher-risk group than RCP criteria, but overlook a patient group with similar poor outcomes.

This systematic review and meta-analysis was performed to determine the influence of enhanced recovery programmes (ERPs) on outcomes after gastric cancer surgery. Medline, Embase, the Cochrane library and ClinicalTrials.gov were searched for studies on outcomes of gastrectomy in enhanced recovery or fast-track programmes. The primary outcome measure was post-operative duration of hospital stay (LOHS), and secondary outcome measures were selected based inclusion in two or more studies. Statistical analysis was performed using standardized mean difference (SMD) and odds ratio (OR) as the summary statistics. Fourteen studies, totalling 1676 patients with gastric cancer were analysed, including nine randomized trials. LOHS was significantly shorter after ERP when compared with control patients (CON, SMD -1.10, 95% confidence interval -1.56 to -0.65, p < 0.001), but with significant heterogeneity between studies (I(2) = 93%, p < 0.001). ERP was also associated with reduced serum inflammatory response (CRP: SMD -0.68 (-1.16 to -0.19), p = 0.007; IL-6: SMD -0.62 (-0.94 to -0.29), p < 0.001), less weight loss (SMD -0.79 (-1.11 to -0.46), p < 0.001), and lower cost (SMD -1.02 (-1.59 to -0.45), p < 0.001), as well as a trend toward shorter duration of intravenous infusion (SMD -2.70 (-5.35 to -0.05), p = 0.05). Inclusion in an ERP was not associated with increased post-operative morbidity (OR 0.83 (0.65 to 1.06), p = 0.13) or hospital readmission (OR 1.67 (0.88 to 3.19), p = 0.12). From this review the authors concluded that multimodal, standardized perioperative gastrectomy care appears feasible, safe and cost effective.

Left colonic conduits placed retrosternally were safest.

Objectives: Access to hearing health care is limited in many parts of the world. Specifically, many risk factors for hearing loss are present in the First Nations people of Canada’s North. No research has been done to assess this populations hearing in over 3 decades. The aims of the study were: (1) Determine the prevalence of hearing loss in children in Baffin Island. (2) Demonstrate the use of asynchronous tele-audiometry. (3) Conduct a cost-benefit analysis of iPad audiometry in the Canadian Arctic. Methods: iPad audiometers were used to test hearing in 220 children ages 5-11 years in Iqaluit, Nunavut, during 1 week in January 2014. Air conduction pure tones were obtained from each ear at frequencies of 500, 1000, 2000, and 4000 Hz. Children with hearing loss greater than 25 dB in at least 1 frequency were considered to have failed the hearing test and will be further tested with standard sound booth audiometry. Results: Preliminary analysis reveals a hearing loss prevalence of 15.5%. These children then received standard testing by an audiologist using standard sound booth audiometry and the results analyzed. A cost-benefit analysis assessed the use of iPad audiometry in this remote location. Conclusions: This is the first study in over 30 years assessing the hearing of children in this region, and the first telemedicine audiometry in Canada using iPads. This type of testing is valuable for providing hearing health care for high risk populations in rural and remote areas at an affordable cost.