Lake District Hospital

INTRODUCTION: Preeclampsia complicates 2–8% of pregnancies and is a major contributor to maternal and perinatal morbidity and mortality. Aspirin (ASA) is known to decrease rates of preeclampsia in patients at risk for developing the disease. We examined provider compliance with the U.S. Preventive Services Task Force risk-based aspirin prophylaxis guidelines at our institution and identified a need for improvement. METHODS: For quality improvement, we implemented provider education, updated patient history forms, and an embedded ASA checklist within our note template. We retrospectively reviewed demographics, medical/obstetric history, and candidacy/prescription placement for two patient groups at their first prenatal visit. The first was the preintervention group (January 1 to June 30, 2019; N=434) and the second was the postintervention group (July 1 to September 30, 2021; N=284). Preintervention and postintervention data were then compared to determine whether rates of compliance with ASA prophylaxis guidelines improved. RESULTS: A similar proportion of patients met criteria for ASA prophylaxis preintervention (43.1%, 95% CI 38.5–47.8%) and postintervention (46.8%, 95% CI 41.1–52.6%, P=.36), with similar proportions of patients who qualified with one high risk factor versus multiple moderate risk factors. There were significantly more patients who qualified for aspirin and were not identified in the preintervention group (67.9%, 95% CI 60.9–74.2%) than in the postintervention group (18.8%, 95% CI 13.0–26.3%, P<.0001). This improvement was even more pronounced in patients who only qualified by moderate risk factors (preintervention [79.7%, 95% CI 72.5–85.5%] versus postintervention [21.2%, 95% CI 14.7–29.7%]). CONCLUSION: The implementation of provider education, updated patient history forms, and an ASA checklist significantly improved provider adherence to ASA prophylaxis recommendations.

Microsurgical denervation of the spermatic cord (MDSC) can provide up to an 86% improvement in pain in patients with chronic orchialgia (CO) who have failed conservative management. Failures in MDSC could be due to small diameter nerves (≤1 mm) left behind on the spermatic cord. The objective of this study was to assess if hydrodissection (HD) of the spermatic cord after MDSC could decrease the number of residual nerve fibers without compromising blood flow. Prospective blinded randomized control trial: bilateral MDSC was performed on 22 adult rats (44 cords). HD of the spermatic cord was performed on one side of each rat (side randomized) using the ERBEJET2. The contralateral cord (no HD) was the control for each animal. Blood flow through the vessels was monitored using a micro-Doppler probe. After completion a cross-section of the residual cord was sent to pathology (blinded to technique) to assess for small diameter nerves and signs of damage in vascular integrity. Blood flow had been maintained in the vessels when the ERBEJET2 was set to 6 bar (87 psi). The cord where HD had been performed had a significantly lower total median residual nerve count of 5 (0-10), compared to 8 (2-12) on the non-HD side (p = 0.007). No structural damage was seen in the vessels in the spermatic cord that had undergone HD (gross exam and histology). HD of the spermatic cord significantly decreases residual nerve density without compromising vascular integrity in a rat model.

Microsurgical denervation of the spermatic cord (MDSC) is a treatment option in patients with chronic orchialgia. This procedure requires precise care to avoid any thermal damage to crucial adjacent tissues (arteries, veins, and lymphatics). Monopolar electrocautery is the standard ligation energy source, but may cause extensive collateral damage to the tissues. However, CO2 laser is known to produce a very predictable tissue penetration and minimal collateral spread. The goal of this study was to compare the extent of collateral thermal damage in both monopolar electrocautery and CO2 laser ablation in the spermatic cord during a robotic assisted MDSC (RMDSC) procedure as well as the feasibility for utilizing the flexible fiber-optic CO2 laser probe after "RMDSC" procedure. RMDSC was performed using standard monopolar electrocautery on the spermatic cord of one side of a fresh human male cadaver (randomly selected) and then compared to RMDSC using the CO2 laser on the contralateral spermatic cord. Nine histological cross-sections from each cord were measured for depth of collateral thermal/cautery injury. The mean collateral thermal injury with CO2 laser was 0.17 ± 0.031 mm (range: 0.15-0.25 mm), and with standard electrocautery 0.72 ± 0.046 mm (range: 0.60-0.75 mm). CO2 laser resulted significantly less collateral thermal injury than standard electrocautery (p < 0.0001). The CO2 laser probe was easy to manipulate with the Black Diamond micro-forceps (Intuitive Surgical, CA) and allowed for convenient tissue plane dissection. Human cadaveric targeted RMDSC using a flexible CO2 laser energy results in significantly decreased collateral thermal injury compared to standard monopolar electrocautery. These initial findings suggest potential advantages of the CO2 laser over traditional monopolar cautery in cases requiring minimal collateral tissue damage. Future studies are needed to assess its clinical potential in microsurgery.

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.

Blastomycosis is potentially fatal, but environmental risk factors for acquiring blastomycosis are not well established. Matched cross-sectional questionnaire of 112 patients with history of blastomycosis and 118 control subjects in Manitoba and northwestern Ontario. The most common tissues involved with blastomycosis were pulmonary, skin and soft tissues, and bone. A significantly greater proportion of patients with blastomycosis than control subjects were involved in outdoor occupations. A significantly greater percentage of patients with blastomycosis were immunosuppressed either from collagen vascular disease or immunosuppressive therapy, or had hypothyroidism. A significant association between canine and human blastomycosis was not observed. Independent risk factors for development of blastomycosis included immunosuppression for any reason (including drugs or disease), collagen vascular disease, being an outdoor worker, and having a coworker with blastomycosis. Canine blastomycosis was not a risk factor for human disease in dog owners.

The LHC will provide proton-proton collisions at energies of about 14 TeV and at luminosity up to 10¡ £¢ cm¤ ¦¥ s¤ ¨ § .It will be possible to observe new physics but also to have precise measurements of Standard Model phenomena.The perspectives for top quark physics, electro-weak physics, gauge boson couplings and B physics with CMS are briefly discussed here.With the high rate and energy, new processes from the Standard Model, as for example single top, will become visible.

An otherwise well 21-year-old man from Northwestern Ontario presented to our emergency department in Winnipeg, Manitoba, with a 2-month history of cough, progressively increasing dyspnea, hemoptysis and a 15-kg weight loss. His symptoms were worsening despite antibiotic treatment for presumed bacterial pneumonia. His past history included work as a seasonal labourer clearing brush. He was not hypoxic on room air, but his chest radiograph revealed a miliary pattern and bilateral infiltrates. A Mantoux test for tuberculosis was non-reactive, and the sputum gram stain was unremarkable. Empiric therapy was initiated for blastomycosis and the diagnosis was confirmed with a calcofluor stain of the sputum. Although blastomycosis is rare in most regions in North America, there is an unusually high incidence of blastomycosis in Northwestern Ontario. This case highlights the intolerance and utility of knowledge of the local epidemiology in establishing difficult diagnoses of regional importance, such as fungal pneumonias.