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BACKGROUND: Mixed Arterial and Venous Leg Ulcers (MAVLU) are challenging. Clinical evidence specific to MAVLU management is scarce. We evaluated our recent experience with MAVLU patients and reviewed current data regarding MAVLU epidemiology, aetiology, diagnostic assessment and management options. METHODS: A prospective leg ulcer database was retrospectively interrogated to determine the prevalence and clinical outcome of MAVLU over 2-year period (2021-2022). The literature was reviewed to determine if optimal treatment strategies. RESULTS: 307 patients attended the ulcer clinic over a 2-year period. Most were venous leg ulcers (71%), 24% were arterial and 5% were MAVLU. The highest healing rate was in MAVLU (93%), followed by (74%) and (41%), in arterial and venous leg ulcer groups, respectively. CONCLUSION: Evidence-based guidelines for MAVLU remain lacking. Well-developed randomised controlled trials are warranted to guide current clinical practice.

Asunto(s)

Bases de Datos Factuales , Úlcera Varicosa , Cicatrización de Heridas , Humanos , Úlcera Varicosa/epidemiología , Úlcera Varicosa/terapia , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/fisiopatología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Resultado del Tratamiento , Estudios Retrospectivos , Factores de Tiempo , Prevalencia , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/epidemiología , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Factores de Riesgo , Anciano de 80 o más Años

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During the 1970s, scientists first used botulinum toxin to treat strabismus. While testing on monkeys, they noticed that the toxin could also reduce wrinkles in the glabella area. This led to its widespread use in both medical and cosmetic fields. The objective of the study was to evaluate the potential use of Botox in managing post-operative contracture after below-knee amputation. We conducted a systematic review In Pubmed, Cochrane Library, Embase, and Google Scholar using the MESH terms Botox, botulinum toxin, post-operative contracture, amputation, and below knee amputation. Our goal was to evaluate the potential use of Botox to manage post-operative contracture in patients who have undergone below-knee amputation. Our findings show evidence in the literature that Botox can effectively manage stump hyperhidrosis, phantom pain, and jumping stump, but no clinical trial has been found that discusses the use of Botox for post-operative contracture. Botox has been used in different ways to manage spasticity. Further studies and clinical trials are needed to support the use of Botox to manage this complication.

Asunto(s)

Amputación Quirúrgica , Toxinas Botulínicas Tipo A , Contractura , Fármacos Neuromusculares , Complicaciones Posoperatorias , Humanos , Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/farmacología , Complicaciones Posoperatorias/tratamiento farmacológico , Contractura/cirugía , Contractura/tratamiento farmacológico , Contractura/etiología , Fármacos Neuromusculares/administración & dosificación , Fármacos Neuromusculares/farmacología , Muñones de Amputación

RESUMEN

Background and objective Missing information or mistakes in patients' medical records, including those related to intraoperative and postoperative information, in an operative note can have profound clinical, ethical, and medicolegal implications. Operative notes should be informative, clear, and inclusive of the necessary data and should be collated immediately following surgery. In this study, we aimed to determine the ways to improve the quality of operative notes in the field of vascular surgery. Methods In this retrospective analysis, we compared the operative notes of 32 patients in the Department of Vascular and Endovascular Surgery, University Hospital Galway, against the standard set by the Royal College of Surgeons in Ireland (RCSI) (Code of Practice for Surgeons RCSI, 2018) and presented the results to our departmental staff. To facilitate an improvement in the quality of operative notes, a structured poster checklist was designed and displayed in the operating theatre. Furthermore, a scanner was set up in the operating theatre with clear and easy-to-follow instructions for uploading the operative notes into our hospital's online and digital patient record system (EVOLVE). An explanatory video was circulated among the staff. Three months after the first cycle, two further retrospective cycles were performed. Results A total of 96 patients' operative notes were analysed. Following the intervention, a significant improvement in documentation was noted concerning the dates; procedures followed; as well as the details of surgeons, assistants, anesthetists, incisions, surgery types, operative diagnoses, complications, additional procedures, tissue details, prostheses involved, closure techniques, postoperative plans, and surgeons' signatures. We also observed a significant increase in the uploading of the operative notes in the EVOLVE system. Conclusions The quality of the operative notes improved considerably after staff education, poster display, and scanner installment in the operating theatre. It is important to have an efficient and well-structured plan to improve the process of operative note-keeping, thereby ultimately enhancing overall patient care.

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Background Rectal cancer is a widespread health concern in the UK, and MRI is vital for accurate diagnosis and effective treatment. To enhance the quality of MRI reports for rectal cancer, structured reporting can be utilized. Despite the existence of global guidelines and templates, there is a lack of use for standardized templates. Thus, this study seeks to assess and compare the quality of MRI reports in free text style for rectal cancer at a single hospital with international recommendations. Methodology We conducted a retrospective cohort study on adult patients diagnosed with primary rectal cancer and underwent an MRI of the rectum/pelvis. The study aimed to identify and compare the difference in reporting quality between in-house GI radiologists and out-of-hours outsourced reporting agencies. The quality of reporting was identified based on at least fifteen selected features recommended by the European Society of Gastrointestinal and Abdominal Radiology and the Society of Abdominal Radiology. The study was performed in a General and Colorectal Surgery Department in the North East of England. Results The study retrospectively analysed 94 reports of primary rectal cancer patients over three years. The quality of reporting was compared between in-house GI radiologists and out-of-hours outsourced reporting agencies. The results showed that in-house radiologists had better reporting quality than outsourced agencies in terms of TNM stage (TNM is a notation system that describes the stage of cancer), predicted extramural venous invasion (EMVI), mesorectal fascia involvement (MRF), T stage, and shape. No statistical significance was found for metastasis, node status, further MRF description, peritoneal reflection, or MRI signal. Conclusion The study found that local GI radiologists had better quality reporting than outsourced agencies for rectal cancer MRI reports, but still missed important features. A unified structured reporting template is recommended to improve the quality of MRI reporting for rectal cancer.