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Background: Localizing the source of severe lower gastrointestinal (GI) bleeding is often difficult but is important to plan the extent of colonic resection. The purpose of the present paper was to audit the Auckland Hospital experience of selective angiography, in localizing lower GI bleeding. Methods: Patients admitted to Auckland Hospital with rectal bleeding and who subsequently had angiography were evaluated by reviewing their clinical notes and radiological results during a 7-year period (1997−2003). Data collected included demographic details, haemodynamic parameters, change in haemoglobin level, requirement of blood transfusion within 24 h before the procedure, site of the bleeding and pathology. Results: The notes of 88 patients (male, n = 51; median age 69 years, range 8−99 years) were available for review and analysis. The site of bleeding was localized in 38 (51%); 30 of them had bleeding in the right colon or small bowel and eight in the left colon. Positive localization correlated with: haemodynamic instability P < 0.0001; drop in haemoglobin level of ≥50 from previous admission ( P = 0.02); transfusion requirement of ≥5 units of blood within 24 h ( P < 0.0001). Logistic regression analysis showed transfusion requirement of ≥5 units to achieve haemodynamic stability to be the most powerful predictor of accurate localization (odds ratio, 40). Conclusion: Catheter angiography for acute lower GI bleeding will successfully localize a point of bleeding in approximately 50% of patients. The most useful clinical indicator for positive angiography was haemodynamic instability particularly in those who require transfusion of ≥5 units of blood to achieve haemodynamic stability. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to provide a review, based on collected data, on the topic of ‘fractured zygoma’. The review is presented under the headings of epidemiology, fracture patterns, treatment modalities and complications. Throughout the paper comparison is made with published data from around the world. Methods: A 10-year retrospective audit was undertaken of all hospitalized patients, at the Royal Hobart Hospital, Tasmania, who had sustained a fractured zygoma. All Le Fort fractures involving the zygoma were excluded. Results: A total of 263 fractures was sustained, largely due to assault. Alcohol was a significant contributing factor. Tetrapod fractures were the most frequent type of fractures witnessed. Plating was the most frequently employed fixation. Inferior orbital nerve dysfunction and other complications were seen in 24.6% and 20.7% of follow-up cases, respectively. Open reductions were nearly 4 times more likely to be accompanied by complications if inferior orbital nerve dysfunction was excluded. Conclusions: Both closed and open reductions are good treatment modalities and were used in near equal numbers of patients. There is a higher incidence of postoperative facial deformity in the closed reduction group, but more complications related to the incisions in the open reduction group. Open reduction and internal fixation is advocated for the unstable, markedly displaced or comminuted fractures. Silastic sheeting is a favoured graft for repair of the associated orbital floor defects and is associated with few complications. [ABSTRACT FROM AUTHOR]