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Background: The advantages of simultaneous bilateral total knee arthroplasty (sim‐BTKA) remain controversial. This study investigated the effects of two‐surgeon sim‐BTKA compared to separate admission staged BTKA regarding intraoperative and post‐operative outcomes and health service costs. Methods: Patients underwent sim‐BTKA or staged BTKA between 1 November 2008 and 30 June 2016. Data were extracted from a joint replacement registry and medical records. Median regression and chi‐squared tests were used for between‐group comparisons. Results: Median hospital total length of stay was 5 days less for sim‐BTKA (n = 122) than staged BTKA group (n = 46) (7 versus 12; 95% confidence interval (CI) 3.9, 6.1), and 9 days less for inpatient rehabilitation (17 versus 26; 95% CI 3.7, 14.3). However, 80% of sim‐BTKA patients went to inpatient rehabilitation (versus 27% following staged BTKA), so median total length of stay was 9 days less for staged BTKA (13 versus 22; 95% CI −12.8, −5.2). Total anaesthesia time was 135 min less for sim‐BTKA (P < 0.001), while staged BTKA required less blood transfusions (P = 0.001). Complication rates were similar, except for superficial infections which were observed twice as often after staged BTKA (30% versus 15%, P = 0.048). Twelve months following sim‐BTKA and the first staged total knee arthroplasty, sim‐BTKA had better WOMAC pain, stiffness and function scores (P ≤ 0.05). Average inpatient costs (hospital and rehabilitation) were $6388 less for sim‐BTKA. Conclusion: Sim‐BTKA appears to be a comparatively safe alternative to staged BTKA. Sim‐BTKA may be superior to staged BTKA due to faster improvements in pain and function and lower healthcare costs. How these results generalize to other health services requires further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Fluid management is a cornerstone of treatment in acute pancreatitis (AP). Methods: Identification of existing randomized prospective trials of patients with AP, in which intravenous fluid management was a significant parameter in the experimental design, was undertaken using the PubMed and ENDOBASE databases. Results: Included patients in the seven studies identified were on the whole very unwell with deaths occurring in six trials. Fluid regimens in AP included crystalloid alone, combinations of crystalloid and colloid and in two studies, plasma. In most studies, patients with premorbid major organ failure and advanced age were excluded. Study entry within 6 h of presentation occurred in three trials. Initial fluid administration rates varied from 1 to 2 mL/kg/h to 15 mL/kg/h. Rapid fluid rates were associated with increased morbidity and mortality except in one study in which a high fluid regimen (20 mL/kg bolus within 4 h of presentation followed by 3 mL/kg) led to a better clinical outcome than a more conservative regimen. Use of Ringer's lactate led to improved surrogate outcome markers compared to that of normal saline in one study. Administration of colloid as part of the fluid management was associated with lower morbidity and lower fluid requirements. Conclusion: Rapid infusion of crystalloid very early in the course of AP may be beneficial but rapid infusion of fluid later in the course of the illness may be deleterious. Colloid administration and the use of Ringer's lactate solution in preference to normal saline may improve outcome. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 47-year-old female patient who was referred for surgical review with a 23-year history of intermittent right upper quadrant abdominal pain. It discusses the results of her physical examination, magnetic resonance cholangiopancreatography (MRCP) and laparoscopy. The case shows the value of MRCP in investigating post-cholecystectomy syndrome (PCS).