Inferior vena cava (IVC) thrombosis remains under-recognised as it is often not pursued as a primary diagnosis. The aetiology of IVC thrombosis can be divided into congenital versus acquired, with all aetiological factors found among Virchow's triad of stasis, injury and hypercoagulability. Signs and symptoms are related to aetiology and range from no symptoms to cardiovascular collapse. Painful lower limb swelling combined with lower back pain, pyrexia, dilatation of cutaneous abdominal wall veins and a concurrent rise in inflammatory markers are suggestive of IVC thrombosis. Following initial lower limb venous duplex, magnetic resonance imaging (MRI) is the optimal non-invasive imaging tool. Aetiology directs treatment, which ranges from anticoagulation and lower limb compression to open surgery, with endovascular therapies increasingly favoured. The objective of this review is to assess current literature on the aetiology, presentation, investigation, treatment, prognosis and other factors pertaining to IVC thrombosis.

Background: Acute appendicitis remains the most common cause of the acute abdomen in young adults, and the mainstay of treatment in most centres is an appendectomy. However, treatment for other intra-abdominal inflammatory processes, such as diverticulitis, consists initially of conservative management with antibiotics. The aim of this study was to determine the role of antibiotics in the management of acute appendicitis and to assess if appendectomy remains the gold standard of care. Methods:A literature search using MEDLINE and the Cochrane Library identified studies published between 1999 and 2009, and we reviewed all relevant articles. The articles were critiqued using the Public Health Resource Unit (2006) appraisal tools. Results:Our search yielded 41 papers, and we identified a total of 13 papers within the criteria specified. All of these papers, while posing pertinent questions and demonstrating the role of antibiotics as a bridge to surgery, failed to adequately justify their findings that antibiotics could be used as a definitive treatment of acute appendicitis. Conclusion:Appendectomy remains the gold standard of treatment for acute appendicitis based on the current evidence.Contexte : L'appendicite aiguë demeure la plus fréquente cause de l'abdomen aigu chez les jeunes adultes et dans la plupart des centres, la base du traitement repose sur l'appendicectomie. Toutefois, le traitement des autres processus inflammatoires intraabdominaux, comme la diverticulite, consiste initialement en une prise en charge conservatrice par antibiothérapie. Cette étude avait pour but de déterminer le rôle des antibiotiques dans la prise en charge de l'appendicite aiguë et de vérifier si l'appendicectomie reste la norme thérapeutique. Méthodes : Une interrogation des publications dans MEDLINE et la Collaboration Résultats :Notre recherche a retrouvé 41 articles, et nous avons retenu 13 articles à partir des critères spécifiés. Tous, même s'ils posaient des questions pertinentes et établissaient le rôle de l'antibiothérapie comme étape de transition avant la chirurgie, ont échoué à démontrer de façon adéquate leurs conclusions selon lesquelles les antibiotiques pourraient être utilisés en traitement définitif de l'appendicite aiguë. Conclusion :Si l'on se fie aux preuves actuelles, l'appendicectomie reste la norme thérapeutique privilégiée pour le traitement de l'appendice aiguë. Acute appendicitis is inflammation of the vermiform appendix and remains the most common cause of the acute abdomen in young adults. The mainstay of treatment in most centres is an appendectomy, and, consequently, this is one of the most common operations performed on the acute abdomen.1 However, appendicitis can be notoriously difficult to diagnose, and there exists a negative appendectomy rate of 10%-20% despite the use of preoperative computed tomography (CT). [2][3][4][5][6] In addition, as with all operations, postoperative complications exist, including wound infections, intra-abdominal abscesses, ileus and, in the longer term, adhesions....

Atrial fibrillation increases lifetime stroke risk. The left atrial appendage (LAA) is thought to be the source of embolic strokes in up to 90% of cases, and occlusion of the LAA may be safer than the alternative of oral anticoagulation. Occlusion devices, such as the AtriClipTM (AtriCure, Mason, OH, USA) enable safe and reproducible epicardial clipping of the LAA. A systematic review was performed in May 2018, based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, using the keyword ‘AtriClip’. A total of 68 papers were identified and reviewed; 11 studies were included. Data including demographics, medical history intervention(s) performed, periprocedural outcomes and follow-up were assessed and analysed. A total of 922 patients were identified. LAA occlusion was achieved in 902 out of 922 patients (97.8%). No device-related adverse events were reported across the studies. The reported incidence of stroke or transient ischaemic attack post-clip placement ranged from 0.2 to 1.5/100 patient-years. Four hundred and seventy-seven of 798 patients (59.7%) had ceased anticoagulation on follow-up. The AtriClip device is safe and effective in the management of patients with atrial fibrillation, either as an adjunct in patients undergoing cardiac surgery or as a stand-alone thoracoscopic procedure.

BackgroundA solitary diverticulum of the caecum is a rare benign condition which was first described by Potier in 1912 [1]. Clinical symptoms are usually a manifestation of complications arising from inflammation, perforation or haemorrhage. Despite radiological imaging, a pre-operative diagnosis is infrequent.Case presentationWe report two cases of right iliac fossa pain associated with a solitary caecal diverticulum. We discuss the clinical presentation, investigative modalities, and current therapeutic guidelines associated with this rare condition and highlight the difference from the more common conditions of appendicitis in the young and caecal neoplasms in the older patient.ConclusionComplications of a solitary caecal diverticulum should be considered in the differential diagnosis of acute right lower quadrant pain. Mild caecal diverticulitis verified pre-operatively by radiological imaging or laparoscopically can be ameliorated by antibiotics alone. However, severe inflammation, perforation, haemorrhage or torsion necessitates a localised or radical resection. The presence of multiple diverticula, caecal phlegmon, or the inability to rule out an underlying caecal neoplasm warrants a right hemicolectomy.

Delayed referral to a renal specialist adversely affects patient outcomes. This study suggests that the implementation of a virtual renal clinic for non-complex renal pathologies can offer a cost-effective, rapid referral mechanism for patient assessment combined with readily available specialist advice.