Palmerston North Hospital is the main public hospital in Palmerston North, New Zealand. The hospital is located at the northern end of Ruahine Street, 2 km (1.2 mi) northeast of The Square. It is the main hospital run by the MidCentral District Health Board, which primarily serves Palmerston North and the surrounding Manawatu, Tararua and Horowhenua districts.The hospital has 354 inpatient beds as of 2020. The hospital is a major trauma centre, one of four in the lower North Island alongside Hawke's Bay Hospital, Whanganui Hospital and Wellington Regional Hospital.
To compare perioperative, oncological, and survival outcomes of total gastrectomy (TG) versus subtotal gastrectomy (SG) in patients with locally advanced distal diffuse gastric adenocarcinoma treated with perioperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy. Diffuse distal gastric cancer is characterized by infiltrative growth patterns and early nodal metastasis. Whilst radical resection remains the cornerstone of curative treatment, the optimal extent of surgery with TG or SG, remains debated. This international multicenter cohort study analyzed data from patients with histologically confirmed diffuse gastric adenocarcinoma, located > 5 cm from the gastroesophageal junction. Endpoints included surgical margin status, nodal yield, perioperative morbidity, recurrence patterns, time-to-recurrence (TTR), and overall survival (OS). Outcomes were compared using multivariate analyses. In total, 188 (39.0
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Case Submission We present a diagnostically challenging case of postoperative hemorrhage following hybrid Ivor-Lewis esophagectomy, highlighting the limitations of standard coagulation testing and the clinical impact of overlooked antiplatelet agents and complementary therapies. A 63-year-old man underwent esophagectomy for locally advanced adenocarcinoma after neoadjuvant chemotherapy. Six hours postoperatively, he became hemodynamically unstable, with hemoglobin dropping from 98 to 68 g/L. Re-exploration revealed no surgical source of bleeding. Intraoperative thromboelastography (TEG) was normal. Endoscopy, however, identified an actively bleeding duodenal ulcer requiring operative hemostasis. ADP platelet function testing demonstrated significant platelet inhibition. It was only later that the patient disclosed chronic use of ibuprofen, diclofenac, and Turkey Tail mushroom extract, which he had begun after reading about its use in Japanese cancer care. This case illustrates the underappreciated risk of NSAID-associated platelet dysfunction and gastrointestinal bleeding, particularly in the perioperative setting. Non-selective NSAIDs such as ibuprofen and diclofenac impair thromboxane A₂–mediated aggregation and increase mucosal vulnerability to ulceration. Though routinely prescribed for analgesia, their use immediately prior to major surgery warrants careful consideration — especially when multiple agents are involved. While the hemostatic effects of complementary medicines are less well understood, their growing prevalence in cancer patients introduces an additional layer of risk. Trametes versicolor (Turkey Tail), widely used in Japan as an adjuvant therapy for gastrointestinal cancers, contains polysaccharide-K (PSK), an immunomodulatory compound believed to enhance natural killer cell and T-cell activity. Emerging data suggest PSK may also interfere with platelet aggregation and adhesion, although its perioperative significance remains unclear. In this case, concurrent use of NSAIDs and Turkey Tail extract may have had additive effects on platelet dysfunction. Importantly, this case highlights the limitations of TEG in detecting qualitative platelet defects, especially when clot strength appears preserved. ADP-based assays offer better sensitivity to COX- and P2Y12-mediated dysfunction and should be considered when bleeding occurs despite normal TEG parameters. This case invites discussion on: • When to escalate to platelet function testing in the setting of unexplained bleeding • Best practices for screening use of NSAIDs and oncology-adjunct complementary therapies (e.g., medicinal mushrooms such as Turkey Tail/PSK) that may impair platelet function • How to proactively identify common non-prescribed health supplements—such as fish oil, ginkgo biloba, and garlic—that may also influence bleeding risk • Whether guidelines should address withholding both prescribed and non-prescribed agents with hemostatic effects in the perioperative period The combined effects of common NSAIDs and increasingly used supplements warrant multidisciplinary attention to ensure perioperative safety in oncology surgery.
Background:Late diagnosis of developmental hip dysplasia (DDH) may warrant either open or closed reduction of the hip. Proximal femoral growth disturbance (PFGD) is a possible complication following these procedures. Methods:A systematic search of PubMed, Embase, Web of Science, The Cochrane Library and OrthoSearch from the date of inception of each database through to the 2 February 2025 was performed. The primary outcome of interest was the prevalence of clinically significant PFGD following open or closed reduction after 6 months of age. This was defined as Kalamchi-MacEwen or Bucholz-Ogden Type 2 or above. Results:The prevalence of clinically significant PFGD in patients undergoing open reduction was 12.47% (95% Confidence interval (CI): 10.39-14.69), whereas the prevalence of clinically significant PFGD in patients undergoing closed reduction was 9.53% (95% CI: 6.91-12.46). Multivariate analysis suggested that mean age at time of reduction was associated with an increase in the prevalence of PFGD in patients undergoing closed reduction (p = 0.022). Conclusion:We described the prevalence of clinically significant PFGD following closed reduction and open reduction. In both open and closed reduction groups, we observed a high relative heterogeneity (I 2), but acceptable absolute heterogeneity (τ 2), and pooled prevalence estimates should be interpreted with caution. Further studies exploring the influence of disease severity and age on treatment method is required to allow reliable comparisons between open and closed reduction. PROSPERO Registration No:CRD420251015622.
Kidney transplantation (KT) is the most effective treatment for end-stage kidney disease. With advancements in modern immunosuppression, graft survival rates for standard-risk recipients have significantly improved, reaching approximately 95% in the first year, 85% at five years, and 65% at 10 years. However, long-term outcomes remain challenging due to chronic graft loss and drug-related toxicities. Immunosuppressive drugs, with narrow therapeutic range of safety and efficacy, require drug-monitoring strategies to optimize outcomes. In KT, the standard triple maintenance regimen of tacrolimus, mycophenolate mofetil (MMF), and prednisolone is practiced and MMF is typically administered as a fixed-dose drug. However, evidence suggests that dosage adjustments based on concentration monitoring yield superior clinical outcomes. MMF, an ester prodrug of mycophenolic acid (MPA), necessitates area under the concentration curve (AUC) monitoring due to its complex pharmacokinetics and an exposure level of 30-60mg/Lh is considered adequate for transplant recipients. However, fixed dosing practices continued, due to controversial evidence and lack of familiarity with AUC and monitoring techniques. AUC monitoring has also been proposed for tacrolimus, a calcineurin inhibitor (CNI), instead of routinely used trough concentration, particularly in "rapid metabolizers" who may experience higher peak concentrations and toxicities. To enhance transplant outcomes, a comprehensive understanding of AUC and relevance to immunosuppressant exposure is critical. This review will primarily focus on MPA AUC exposure in post-kidney transplant patients, explore and explain methods for AUC monitoring, and highlight recent developments in tacrolimus AUC monitoring.
Objectives: For end-stage kidney disease (ESKD) patients on maintenance haemodialysis (MHD), end-of-life care (EOLC) and dialysis discontinuation are established in Western nations, but family perspectives in the intensive care unit (ICU) remain understudied in developing nations like India. This study examined families’ perceptions of EOLC, dialysis withdrawal and life-sustaining drug discontinuation for MHD patients in our ICU, where the Kidney Supportive Care (KSC) team was part of the Primary Medical Board (PMB). Materials and Methods: A cross-sectional survey examined family input for MHD ICU patients undergoing EOLC and dialysis discontinuation assisted by KSC team (palliative care expert, nephrologist and intensivist). We gathered baseline data, ICU admission causes, 24 h pre-death symptoms and withdrawal advice and used Statistical Package for the Social Sciences 21 for statistical analysis. Results: 23/98 MHD patients (82.6% male, mean age 57 ± 12.09 years) underwent EOLC. ICU admissions were mostly for infection (47.8%). The most prevalent pre-death symptom was agitation (86.9%). Haemodynamic decline (82.6%) and disease progression (69.5%) drove withdrawal. All patients underwent dialysis withdrawal and had ‘Do Not Resuscitate orders instituted. The rate of ventilator and inotrope withdrawal was 80% and 50%, respectively. 74% of families attended, and 20% received spiritual leader visits during EOLC. All participating family members reported no guilt and provided positive feedback for KSC team engagement during EOLC. Conclusion: Our study highlights complete agreement of families on dialysis withdrawal and providing EOLC support in our ICU setting for ESKD patients. It also emphasises the need for a dedicated PMB with the KSC team for a better EOLC, which provides family satisfaction and avoids redundant interventions.
