Background/Aims: Evolving surgical practice has placed increasing pressures on surgical outpatient clinics. This article provides a prospective evaluation of a rapid-access coloproctology clinic over a 3-year period. Methods: Primary care physicians (PCP) were circulated details of the clinic, and invited to refer any patient presenting with colorectal or anorectal symptoms, or with a family history of bowel cancer wishing advice about screening. Data were collected prospectively and patients and the referring PCPs were invited to complete a self-administered structured questionnaire. Results: In all, 3,119 patients were referred, the main indications being rectal bleeding (67%), abdominal pain (16%) and change in bowel habit (15%). The average time interval between PCP visit and specialist consultation was 2 days and neoplastic disease was detected in 7.1% of patients. 70% of patients with haemorrhoids and 39% of those with other minor diseases were discharged back to their PCPs after definitive treatment at the time of their visit to the clinic. The majority of PCPs and patients expressed satisfaction with the service as evidenced by the returned questionnaires. Conclusion: These data show that a more universal implementation of such clinics may result in improved care of colorectal disease and considerable savings of outpatient time and resources.

Background: Ultrasound-guided regional anesthesia has gained popularity over the last decade. This study aimed to assess whether YouTube videos sufficiently serve as an adjunctive tool for learning how to perform an ultrasound-guided brachial plexus block (BPB). Methods: All YouTube videos were classified, based on their sources, as either academic, manufacturer, educational, or individual videos. The metrics, accuracy, utility, reliability (using the Journal of American Medical Association Score benchmark criteria (JAMAS)), and educational quality (using the Global Quality Score (GQS) and Brachial Plexus Block Specific Quality Score (BSQS)) were validated. Results: Here, 175 videos were included. Academic (1.19 ± 0.62, mean ± standard deviation), manufacturer (1.17 ± 0.71), and educational videos (1.15 ± 0.76) had better JAMAS accuracy and reliability than individual videos (0.26 ± 0.67) (p < 0.001). Manufacturer (11.22 ± 1.63) and educational videos (10.33 ± 3.34) had a higher BSQS than individual videos (7.32 ± 4.20) (p < 0.001). All sources weakly addressed the equipment preparation and post-procedure questions after BSQS analysis. Conclusions: The reliability and quality of ultrasound-guided BPB videos differ depending on their source. As YouTube is a useful educational platform for learners and teachers, global societies of regional anesthesiologists should set a standard for videos.

Background: We investigated the prognostic value of pre-procedural Thrombolysis in Myocardial Infarction (TIMI) flow for major adverse cardiac events (MACE) and cardiovascular death (CVD) using Korean registry data in ST-elevation myocardial infarction patients underwent primary percutaneous coronary intervention. Methods: Between October of 2005 and May of 2013, a total of 16,843 patients were registered. Of these, 8,428 patients (mean age 62.8 years) were enrolled. Depending on pre-procedural TIMI flow, we divided into 2 groups by TIMI flow 0-2 vs. 3. Results: During follow-up (median 350 days), 938 (11.1%) of MACE and 488 (5.8%) CVD occurred. Preprocedural TIMI 3 flow group showed high event rates in ≤ 30 day MACE (3.5% vs. 5.9% p = 0.001), ≤ 30 day CVD (2.4% vs. 4.8%, p = 0.001), 1-year MACE (9.4% vs. 11.4% p = 0.047) and 1-year CVD (3.8% vs. 6.1% p = 0.002). In the multivariate Cox regression analysis, pre-procedural TIMI 0-2 flow was not an independent predictor of ≤ 30 day MACE, ≤ 30 CVD, 1-year MACE, and 1-year CVD. Conclusion: The pre-procedural TIMI 0-2 flow is not independent predictor of ≤ 30 day MACE and ≤ 30 day CVD, 1-year MACE, and 1-year CVD.

Introduction/purposeStenting of a dural sinus for idiopathic intracranial hypertension (IIH) (pseudotumor cerebri), is becoming recognized as a potential cure for the subgroup of patients who have venous outflow obstruction. The reported number of stenting cases in the world literature more than tripled in the last half of 2011, when another 103 cases were added to the previously reported 42 cases. New stenosis formation in the transverse sinus (TS) above the stent has been mentioned casually in the literature, without any angiographic images showing this pattern of recurrence. The only report of this phenomenon in a case series was in 6/52 patients (12%) (Ahmed RM, Wilkinson M, et al. AJNR 2011;32:1408–14). They reported clinically successful outcomes after restenting in all six patients, five with a single restenting and one with three restentings. The latter case is the only report of failure after repeat stenting, without details or images. These authors theorized that the collapsed transverse sinus was a “Starling resistor” (resistance is dependent on ambient pressure) and that stenting of the TS would reverse pseudotumor pathophysiology even if the primary problem is not venous outflow obstruction. They suggested that stenting of the entire transverse sinus might prevent hemodynamic failure. We will present our current results, with previously unreported follow-up angiographic images and hemodynamic documentation of patients who have developed further stenoses and recurrent elevated pressure gradients after restenting.Materials and MethodsAt present we have angiographic and hemodynamic follow-up on 18 of 22 patients in whom we have performed unilateral dural sinus stenting. These 18 patients included 6 males and 4 females who were “atypical” (BMI ≤25 in two teen agers, 16 and 17-year old, and two female patients in their 50s. There were eight “typical” pseudotumor patients (overweight females of childbearing age).ResultsFive patients developed recurrence of the pressure gradient between the superior sagittal sinus and the internal jugular vein, with development of a new stenosis in the TS above the stent, and a recurrent pressure gradient across the new stenosis. We restented the newly stenosed TS segment in three patients. Two of the three then redeveloped new stenoses in the torcular/superior sagittal sinus region above the second stent, as well as new stenoses in the contralateral TS, with a second recurrence of the pressure gradient. One of our hemodynamic failures occurred in a patient in whom the entire TS was stented. This patient has not been restented. While this hemodynamic failure phenomenon has occurred in 28% (5/18) of our patients overall, all five have occurred in females, and four have occurred in the eight patients who are “typical” IIH patients (50% of “typical” patients).ConclusionsStenting of the entire transverse sinus does not universally prevent restenosis above the stent. Restenting in new TS stenosis above the first stent did not prevent further hemodynamic failure. New stenoses abov...