Effective postoperative recovery after video-assisted thoracoscopic surgery (VATS) remains a significant challenge, with patients frequently experiencing moderate to severe pain, pulmonary decline, and postoperative nausea and vomiting (PONV) despite modern multimodal analgesia. Intravenous lidocaine has been proposed as an opioid-sparing adjunct with systemic analgesic and antihyperalgesia properties, but its role in VATS is uncertain. This systematic review and meta-analysis identified a total of 31 studies, of which 9 randomized controlled trials involving 672 patients met the inclusion criteria and were included in the final quantitative and qualitative synthesis. Five trials (n = 328) assessing 24-hour opioid use and 3 trials (n = 242) assessing 48-hour use showed no reduction in postoperative morphine consumption with lidocaine. Similarly, pooled movement pain scores at 24 and 48 hours (3 trials, n = 200 each) demonstrated no significant difference between groups. Although 4 trials (n = 272) reported a marked reduction in intraoperative remifentanil requirements, this did not translate into improved postoperative analgesia. In contrast, lidocaine produced a consistently favorable antiemetic effect: 5 trials (n = 360) showed a significant reduction in PONV with negligible heterogeneity. Limitations included small sample sizes, varying bolus and infusion regimens, heterogeneity in background analgesic protocols, and incomplete reporting of outcomes such as inflammatory markers and pulmonary physiology, all of which reduce confidence in effect estimates. Overall, current evidence indicates that while intravenous lidocaine is safe and offers a reproducible reduction in PONV, it does not improve postoperative pain or opioid consumption following VATS. Larger, standardized trials are required to determine whether specific subgroups or dosing strategies may yield a greater benefit in thoracic minimally invasive surgery.
Mesalazine is widely used in the management of ulcerative colitis and is generally well tolerated. Rarely, it can cause eosinophilic pneumonitis, a potentially serious form of drug-induced lung injury that often mimics infection. We report a 24-year-old male with longstanding ulcerative colitis on mesalazine therapy for 2 years and 4 months who presented with progressive dyspnea and non-resolving pulmonary infiltrates. Despite empirical antibiotic therapy, his respiratory symptoms worsened. Investigations revealed marked peripheral eosinophilia and bilateral subpleural ground-glass opacities on CT imaging. Mesalazine-induced eosinophilic pneumonitis was suspected. Drug withdrawal and systemic corticosteroid therapy resulted in rapid clinical and radiological improvement. This case highlights that mesalazine-related pulmonary toxicity may occur even after prolonged stable therapy and should be considered in patients with ulcerative colitis presenting with unexplained or non-resolving respiratory symptoms.
Ectopic adrenocorticotropic hormone (ACTH) secretion is an uncommon but potentially life-threatening paraneoplastic syndrome; most often associated with pulmonary neuroendocrine tumours. Gastrointestinal malignancies represent a rare source and may be diagnostically challenging, particularly in the absence of classical phenotypic features of Cushing’s syndrome. We report the case of a 68-year-old woman with metastatic small bowel adenocarcinoma who presented with severe, persistent hypokalaemia, hypocalcaemia and hypomagnesaemia identified incidentally during routine pre-chemotherapy assessment. Despite aggressive intravenous replacement and repeated hospital admissions, electrolyte abnormalities remained refractory. The disproportionate severity of metabolic derangement and evidence of renal potassium wasting prompted endocrine evaluation, which revealed marked ACTH-dependent hypercortisolism with failure of dexamethasone suppression. Pituitary imaging was normal. Histopathological re-review of tumour tissue demonstrated neuroendocrine differentiation, supporting a diagnosis of ectopic ACTH secretion. Initiation of medical adrenal blockade with metyrapone, alongside physiological glucocorticoid replacement, resulted in rapid biochemical stabilization and clinical improvement. This case highlights the importance of recognising ectopic ACTH secretion as a cause of refractory dyselectrolytaemia in oncology patients and underscores the need for early endocrine involvement when standard explanations fail.
Abstract Aim To investigate the outcomes of patients with locally advance rectal adenocarcinoma (LARC) who had opportunistic complete clinical response (cCR) after neo-adjuvant chemoradiotherapy (NCRT) and opted for wait and watch approach. Methods A retrospective review of cases treated at a single Unit in United Kingdom for last 11 years (2014-2025). Patients with excised rectal polyp cancers followed by radiotherapy were excluded. All patients met criteria for NCRT as per index staging. Analysis of their outcomes and survival was undertaken. Results Thirty-one patients were included with median age of 72 years (IQR 63–80, M:F 1:1). About 74% and 16% were moderately and poorly differentiated adenocarcinoma, respectively. The pre-treatment tumour staging included T2=27%, T3=73%, N0=30%, N1=37%, N2=33%, M0=93.5%, M1=6.4%. The median follow-up period was 47 months (IQR 28 – 71). After cCR, patients were assessed every 3-4 months. Cancer regrowth within rectum occurred in 16 (52%) patients, 2 (6.4%) had concurrent liver metastasis. Fourteen patients (45%) underwent salvage radical surgery. The histopathology staging was ypT2=21%, ypT3=43%, ypT4=36%, ypN0=71%, ypN1=28.5%, R0=71%, R1=21%, R2=7%. About 6 (19%;) patient died during the follow-up period, 4 (13%) after salvage surgery. The median disease free and overall survivals were 22 months and 109 months, respectively. Conclusions Patients with LARC who achieve opportunistic complete clinical response can be considered for rectal preservation. Frequent monitoring is key for successful wait and watch approach. Patients should be made aware of the risks which include tumour re-growth (50%) within first two years and high frequency of positive resection margins.
