Splenogonadal fusion: aiding detection and avoiding radical orchidectomy

Splenogonadal fusion is a rare benign congenital anomaly in which there is an abnormal connection between the gonad and the spleen. It was first described over 100 years ago with limited reports in the literature since then. Its similarity in presentation to testicular neoplasia poses a significant challenge in diagnosis and management, often resulting in radical orchidectomy. We present the case of a 31-year-old man who presented with a rapidly growing left-sided testicular mass and suspicious ultrasound findings; histology from the subsequent radical inguinal orchidectomy showed findings consistent with splenogonadal fusion. We describe points for consideration in the clinical history, examination and imaging that could suggest splenogonadal fusion, including preoperative technetium-99m-sulfur colloid imaging and intraoperative frozen section evaluation, which may confirm the diagnosis and prevent unnecessary orchidectomy.

A systematic review of colorectal multidisciplinary team meetings: an international comparison

Background

Colorectal multidisciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of cancer. However, there are no ‘gold standards’ set for this process. The aim of this study was to review the literature systematically and provide a qualitative analysis on the principles, organization, structure and output of CR MDTs internationally.

Methods

Literature on the role of CR MDTs published between January 1999 and March 2020 in the UK, USA and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient-selection criteria, quality assurance, clinical output and outcomes were extracted from data from the UK, USA and continental Europe.

Results

Forty-eight studies were identified that specifically met the inclusion criteria. The majority of hospitals held CR MDTs at least fortnightly in the UK and Europe by 2002 and 2005 respectively. In the USA, monthly MDTs became a mandatory element of cancer programmes by 2013. In the UK, USA and in several European countries, the lead of the MDT meeting is a surgeon and core members include the oncologist, specialist nurse, histopathologist, radiologist and gastroenterologist. There were differences observed in patient-selection criteria, in the use of information technology, MDT databases and quality assurance internationally.

Conclusion

CR MDTs are essential in improving the patient care pathway and should express clear recommendations for each patient. However, a form of quality assurance should be implemented across all MDTs.

Splenogonadal fusion: aiding detection and avoiding radical orchidectomy

Splenogonadal fusion is a rare benign congenital anomaly in which there is an abnormal connection between the gonad and the spleen. It was first described over 100 years ago with limited reports in the literature since then. Its similarity in presentation to testicular neoplasia poses a significant challenge in diagnosis and management, often resulting in radical orchidectomy. We present the case of a 31-year-old man who presented with a rapidly growing left-sided testicular mass and suspicious ultrasound findings; histology from the subsequent radical inguinal orchidectomy showed findings consistent with splenogonadal fusion. We describe points for consideration in the clinical history, examination and imaging that could suggest splenogonadal fusion, including preoperative technetium-99m-sulfur colloid imaging and intraoperative frozen section evaluation, which may confirm the diagnosis and prevent unnecessary orchidectomy.

Inflammation and infarction of adipose tissue: implications in bariatric surgery

Fat necrosis occurs more frequently in patients who have obesity and diabetes mellitus and is linked to worsening of diabetes. Little evidence is available about surgical complications that are related to inflammation and necrosis of adipose tissue. We report two cases of young women with diabetes who underwent bariatric surgery and had complications resulting from extensive inflammation and necrosis of adipose tissue. The first patient was diagnosed with omental infarction, which is a type of fat necrosis that is rarely associated with obesity and bariatric surgery. The second patient had an intraoperative finding of mesenteric panniculitis, which resulted in an intra-operative change in the choice of bariatric surgery to do a sleeve gastrectomy instead of a gastric bypass. Surgeons who perform surgery on bariatric patients must be aware of complications related to excessive amount of adipose tissue.

The effects of severe iron-deficiency anaemia on maternal and neonatal outcomes: A case-control study in an inner-city London hospital

This case-control study investigates the effects of severe iron-deficiency anaemia in pregnancy on maternal and neonatal outcomes in a relatively deprived inner-city population in a North London hospital. The study group comprised of 106 women with haemoglobin (Hb) < 8 g/dl at any point during pregnancy, while controls were 106 women with Hb > 11 g/dl throughout pregnancy. The study group lost an average of 80 ml more blood at delivery (p = 0.032) and had higher rates of postpartum haemorrhage than the control group (27 vs 12 patients, p = 0.012). However, anaemia did not appear to influence other maternal or neonatal outcomes; these may have been confounded by antenatal intervention with oral haematinics or blood transfusion.