Background: Intramuscular long acting testosterone injections are widely used, convenient form of androgen replacement in patients with hypogonadism. Aims: To evaluate the long term effects of parenteral long acting testosterone replacement on patients commenced on treatment in years 2006-2014 and adherence to monitoring undertaken by primary care after discharge from specialist service. Method: We reviewed the results of 64 patients (mean age 58.5 years). Indications for starting testosterone treatment were both primary and secondary hypogonadism. Patients were followed up for an average of 4.33 years (between 3 months and 9 years). Total follow up time was 277.2 patient-years. 53 patients continued with treatment, 7 patients discontinued the treatment and 4 patients died during the follow up period time. We followed the changes of the following blood tests: alanine transaminase (ALT), aspartate transaminase (AST), total cholesterol (TC), haematocrit (HCT), haemoglobin (Hb), prostate-specific antigen (PSA) and testosterone. Adherence to the advised monitoring intervals of these parameters was reviewed. Results: Over the follow up period time the mean changes in the results were as follows: ALT +1.05 IU/L (+5%), TC -0.41 mmol/L (-8.1%), HCT +0.030 (+7.0 %), Hb +7.06 g/L (+4.9%), PSA +0.91 µg/L (+96%), testosterone +19.2 nmol/L (+206%). Adherence to the monitoring intervals advised by our specialist service was: ALT 78.9%, HCT and Hb 80.3%, PSA 52.2% and testosterone 66.3%. Conclusions: Long acting parenteral testosterone replacement in our group of patients resulted in insignificant changes in liver function tests, haematocrit and haemoglobin. We observed a rise in PSA levels, although the mean value remained in the normal range. Reduction of TC levels was noticed and testosterone replacement is reported in the literature to have no adverse effects on lipid profiles. Adherence to the advised monitoring intervals, especially for PSA and testosterone levels needs further attention. METHODDuring the follow up time -out of 64 patients: -53 patients continued with the treatment, -7 patients discontinued the treatment -4 patients died during the follow up period time. We reviewed the adherence to the advised monitoring intervals of the following parameters by primary care after discharge from specialist service. DISCUSSIONDuring the follow up period (on average 4.3 years), on long acting parenteral testosterone replacement we have not observed significant changes in the levels of alanine transaminase (ALT), aspartate transaminase (AST). Thich is consistent with the reports in the literature, as the unfavorable hepatic effects do not appear to be associated with intramuscular injections 1 . We observed only slight increase in the levels of both haematocrit (HCT) and haemoglobin (Hb), 7% and 4.6% respectively. Out of total of 371 checks of HCT, only 5.1 % were in the polycythaemic range (HCT above 51%), which is lower than observed elsewhere 5 . Reduction of total cholesterol levels by 6.4% during the follow up...

Introduction Laparoscopic Cholecystectomy (LC) is the gold standard treatment for symptomatic gallstones. The British Association of Day Surgery (BADS) recommend that at least 60% of LCs are performed as day cases. We investigated the rate of successful discharge for LCs and factors contributing to unexpected overnight stays. Methods Retrospective data analysis was performed on elective LCs between June-November 2019. Electronic records were reviewed for: admission and discharge date; time of procedure; length of procedure; training grade of the surgeon; use of total intravenous anaesthesia (TIVA) or volatile anaesthesia; use of IV morphine in theatre/recovery and reasons for failed discharge. Results A total of 119 patients underwent elective LC, of which 63 were planned day cases. 46 patients (73.0%) listed as day cases were successfully discharged the same day. LCs performed before 1pm had a success rate of 78.8% compared to 45.5% after 1pm (p < 0.05). There was no statistically significant difference in success rates due to length of procedure; training grade of the surgeon; method of induction (TIVA or Volatile) or use of IV morphine in theatre/recovery. 17 planned day cases failed same day discharge. 7 of these patients (41.2%) reported pain and 4 (23.3%) reported nausea, vomiting or dizziness. Conclusion This centre successfully discharged 73.0% of planned day case LCs, although only 52.9% of elective LCs were listed as day cases. Success rates were positively associated with am procedures compared to pm. We recommend a review of operation scheduling and evening staffing in order to increase the probability of discharge on the same day.