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Bleeding related to rectal varices associated with portal hypertension is rare but life‐threatening, and requires prompt treatment. We reviewed the literature for patients with this complex presentation and current recommendations, and commented on a case at our institution of a 68‐year‐old man with Child‐Pugh B alcoholic liver cirrhosis and hepatic encephalopathy who presented with profuse life‐threatening rectal variceal bleeding. Treatment options for rectal varices in patients with hepatic encephalopathy were reviewed and a management algorithm was devised from current knowledge in the literature. We suggest endoscopic management, and if unsuccessful then to proceed to angioembolization and/or balloon‐occluded retrograde transvenous obliteration, which may be used in conjunction with surgical management. The chosen therapeutic option may depend on the clinical condition of the patient, the cause of portal hypertension and clinical expertise or facilities available. Given that transjugular intra‐hepatic portosystemic shunting is contraindicated in patients with hepatic encephalopathy, management of life‐threatening rectal variceal bleeding should be multimodal. [ABSTRACT FROM AUTHOR]

Background: Earlier studies have shown that abnormal levels of haemoglobin and platelets may be associated with worse post‐operative outcomes. We aim to compare the rates of venous thromboembolism (VTE), anastomotic leak and other complications in patients post‐colorectal resection with normal and abnormal levels of haemoglobin and platelets. Methods: We performed a retrospective review of 1610 patients from July 2010 to June 2015 in a single colorectal unit. Our primary outcome was the rate of VTE and anastomotic leak in anaemic and thrombocytopenic patients. Secondary outcomes included length of stay, 30‐day mortality, return to theatre, transfusion rates and Clavien–Dindo classification complications. Results: VTE complications were more common in anaemic patients, and this difference became more pronounced with the severity of anaemia. Other complications such as length of stay >2 weeks occurred more frequently in anaemic and thrombocytopenic patients. A trend towards higher rates of 30‐day mortality and anastomotic leak was noted in patients with anaemia and thrombocytopenia. Conclusion: Anaemia and thrombocytopenia are associated with worse outcomes including length of stay, anastomotic leak, VTE and 30‐day mortality. [ABSTRACT FROM AUTHOR]

To examine practice patterns for breast cancer patients with limited sentinel node ( SN) disease in light of the ACOSOG Z0011 results. Retrospective analysis of patients with T1-2 breast cancer and positive sentinel lymph node biopsy ( SLNB) admitted between January 2009 and December 2012. Patient demographics, tumor characteristics, and treatments were recorded. Eight hundred positive SLNBs were identified. A total of 452 (56.5%) proceeded to completion axillary lymph node dissection ( cALND). cALND rate decreased from 65.1% to 49.7% from 2009-2010 to 2011-2012. cALND was performed for micrometastasis or isolated tumor cells in 39.3% in 2009-2010 and 22.2% in 2011-2012, whereas for macrometastases the rates were 83.1% and 68.6%, respectively. cALND rates diminished for both Z0011-eligible and -ineligible patients. The ACOSOG Z0011 trial presentation and publication coincided with a reduction in cALND for breast cancer with limited nodal disease. There appears equipoise regarding management of macrometastatic SN disease. [ABSTRACT FROM AUTHOR]

Abdominal wall pseudohernia is an unusual complication following herpes zoster. However, it can be confused with a true hernia and should be differentiated from other causes of pseudohernia. We review the published literature to describe the evidence around presentation, investigation, management, and prognosis of this condition. A MEDLINE search was performed in October 2020. The references of identified articles were searched. Studies were included if full text was available and if one case or more of abdominal wall paralysis caused by herpes zoster was described. We identified 72 articles describing 83 cases. The following information was extracted: age, sex, timing of rash and paresis, investigations and timing and completeness of recovery. This presentation occurred more in the elderly (average age of 66.9) and in males (72.6%). The most commonly involved level was T11. In most cases (76.2%), abdominal wall paralysis occurred after the cutaneous manifestations, after an average of 27.6 days. Six patients (7.14%) presented with concurrent cutaneous symptoms and pseudohernia. Seven patients (8.33%) presented with a pseudohernia first. Electromyography was performed in 35 cases (41.7%) and 31 had an abnormal result. Multiple resonance imaging was performed in 13 cases (15.5%): 5 showed an abnormality. Forty-one patients had a complete recovery at an average of 4.29 months. Sixteen patients (19.0%) only had partial recovery. Abdominal wall pseudohernia is an unusual sequel of herpes zoster infection with pathognomonic findings. Prognosis is good with complete or partial recovery for most patients. [ABSTRACT FROM AUTHOR]