HighlightsSubcutaneous emphysema usually follows a benign course, in severe cases it can be debilitating and often requires intervention.Subcutaneous emphysema managed with large-bore drain, maintained on low suction.Simple, safe option with sustained decompression of subcutaneous emphysema.

BackgroundGiant cell arteritis (GCA) has the potential to cause irreversible blindness and stroke in affected patients [1–4]. Temporal artery biopsy (TAB) remains the gold standard test for GCA [6–8]. Recent literature suggests that TAB does not change management of patients with suspected GCA and that ultrasound scan (USS) may be sufficient enough alone to confirm the diagnosis [9–11,13]. The aim of this study is to therefore determine the impact of TAB on current surgical practice and emergency theatre services.Materials and MethodsA retrospective clinical study was performed of patients who had undergone TAB at the Caboolture Hospital from January 2010 to September 2015. Demographic and clinical data was collected from patient's medical records in regards to GCA.ResultsA total of 55 TAB were performed on 50 patients. Only two TAB were positive for GCA. Thirty-eight (76%) patients had a pre-TAB ACR criteria score of ≥3. Pre-operative corticosteroids were administered in forty-five (90%) patients, on average 4 ± 10 days pre-TAB. Mean time to TAB was 1.6 ± 1.6 days following their booking. Ninety-one percent of TAB were performed by surgical registrars. All TAB were performed using local anaesthesia alone.ConclusionsTAB is an expensive procedure with a low positive yield. Recent evidence suggests promising results with USS in diagnosing GCA. With the exceedingly low positive TAB results found in this study, patients with suspected GCA should be investigated in accordance with the above algorithm. The routine use of USS will reduce the number of negative TAB performed.

This study demonstrates a statistically significant improvement in median change-over times using this model. This re-design can be implemented without incurring extra costs, staff, or operating theatres.

HighlightsDe Garengeot hernia is a rare type of femoral hernia that involves an appendix within the hernia sac.Diagnosis is clinically difficult. Imaging may assist in pre-operative diagnosis.There are various surgical methods in the approach to repair of femoral hernia. A recently published surgical method is described in this report.

There is a subgroup of patients with MA who are young females with have low Alvarado scores, have non-diagnostic imaging, and may represent almost one-fifth of appendicectomy specimens. This study supports the probability that MA is a pathological entity.