Traumatic extradural haematoma (EDH) is a common surgical emergency with huge socio-economic impact. Prompt diagnosis and management are key for patient survival and good outcome. Considering that neurosurgical units are mostly only available in tertiary centres, it is a challenge for non-neurosurgical centres to transport patient to the nearest neurosurgical unit for emergency surgery, which may be of significant distance away, hence, a delay in surgery. General surgery units are more widely available and general surgeons are trained to competently manage patients with EDH. Referring to the nearest general surgery unit for emergency surgery for EDH can be life-saving and avoid delay in surgery. There is a lack of study regarding outcome of patients with EDHoperated by general surgeons, hence the aim of this study to investigate in this regard. To determine the post-operative functional outcome of patients with extradural haematoma in a non-neurosurgical centre, and compare the outcome with other centres. Materials andMethods: This study was a retrospective review of records of all post-operative patients operated in HOSHAS for traumatic EDH in year 2017. Sample were obtained from 2017 General Surgery Department operative census in HOSHAS. Data were obtained from patient admission records using a proforma. Documented patient post-operative functional status was classified as per Glasgow Outcome Scale (GOS). Data were analysed using SPSS version 22. Results: A total of 11 patient data were collected. Mean age of the study population is 27. All samples were male patients. Road traffic accident was the main mode of injury (82%). Seven patients had GCS on arrival of 9 to 12 (64%), while 4 patients had severe brain injury on arrival (36%). All except 1 patient with moderate brain injury (GCS on arrival 9-12) recovered well post-operatively. As for patients with severe brain injury on arrival (GCS 3-8), only half of the patients had complete recovery post operatively. Most of the patients (73%) had good post-operative recovery (GOS 4-5). One patient died (GOS 1) and another ended up in vegetative state (GOS 2). The post-operative outcome in this study is comparable to other studies done in neurosurgical unit. Conclusion: The functional outcomes of traumatic EDH patients operated by general surgeons in HOSHAS are similar to those in neurosurgical centre.
Neoadjuvant therapy is the gold standard treatment of locally advanced rectal cancer. It may induce complete sterilization of tumor cell and decreases its local recurrence rate. While 15-20% of patients were found to have pathological complete response (pCR) with combined multimodal therapy, Asian data were generally scarce. pCR rate can indicate the suitability of applying the "watch-and-wait" strategy, which advocates deferment of surgery that can alleviate surgery-associated morbidity.To determine the percentage of pCR of rectal cancer after neoadjuvant therapy. Patients diagnosed with rectal cancer underwent treatment from 2013 to 2017 were retrieved retrospectively. Demographic data, tumor localization, pre- and post-operative pathological reports, neoadjuvant therapy, and pCR status were collected from patients' records. A total of 242 out of 259 patients were treated with definitive rectal surgery. Mean age was 67.1 years old. Chinese ethnicity and male gender were predominant (n = 131, 54.1% and n = 146, 64.3% respectively). More than half (n = 124, 51.2%) had tumor located at mid or low rectum. Histologically, moderate differentiated adenocarcinoma was predominant (n = 227, 93.8%). Merely half (n = 123, 50.8%) of the patients received neoadjuvant chemoradiation therapy, but only 12 (9.8%) had a pCR. From follow-up on these 12 pCR patients, most had 2-year disease-free survival but 1 (8.3%) of the pCR had distant metastasis within 1-year post-surgery. The pathological complete response rate in our center was lower than reported. Stringent patient selection with close follow-up for patients should be carried out if the "watch-and-wait" strategy is implemented in our population.